The Affordable Care Act encourages you to have comprehensive health insurance, but you don’t have to buy it from a government-run obamacare marketplace. private “off-market” health insurance is also available.
Marketplace plans and non-Marketplace plans are generally mirror images of one another, although non-Marketplace plans do not provide premium subsidies and members have to pay for rate increases themselves.
This means that people who don’t receive obamacare tax credits will generally pay less if they choose lower-cost out-of-market health insurance on a private website.
So, what is the insurance market? why would people buy health insurance outside the marketplace instead of a plan available in a state-run marketplace? We’ve broken down the main ways health plans in and out of the marketplace vary—or don’t.
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are off-exchange plans okay? in-market and out-of-market health insurance is the same where it counts
A big question for many people is whether benefits vary between marketplace health insurance and non-marketplace health insurance. essentially, they don’t.
No matter where they are sold, health insurance plans must meet certain standards of the Affordable Care Act.
At a minimum, all health plans in and out of the marketplace must include the 10 essential health benefits (ehbs), which are:
- ambulatory care
- emergency services
- maternity and newborn care
- mental health and substance use disorder services
- prescription drugs
- rehabilitative and habilitative services and devices
- laboratory services
- preventive and wellness services, including chronic disease management
- expanded pediatric services, including dental and vision care
- name and design,
- provider network, and
- participating insurance carriers.
Prior to the annual open enrollment period, each state will select a baseline health insurance plan upon which all other health plans in the state are modeled. plans must offer the same basic benefits, but are not prohibited from including additional benefits.
Inside and outside the bag: key differences
In-Market and Non-Market health insurance plans must be categorized by metal tier: Bronze, Silver, Gold, Platinum, and Catastrophic (only available to those under 30 or over 30 who qualify for a hardship waiver financial/affordability) . As explained above, all of these plans have the same minimum coverage.
The three main ways plans vary in and out of the market are
1. name and design
Specific health insurance plan designs offered on and off the state and federally facilitated exchanges may vary. This means that the same company may offer a bronze plan under one name on private websites and a similar bronze plan under a different name and fewer benefits on a state’s obamacare exchange. one can be a ppo and the other can be an hmo. one may offer additional benefits that the other does not.
- Example: Company A may offer a plan that calls the profitable bronze hmo on a state exchange. Company A cannot offer that same plan in the private market. the company a only offers the cheap bronze ppo in the private market. Both plans include the 10 essential health benefits, but their network structures (hmo vs. ppo) and other benefits differ.
- Example: The provider network associated with Company B’s profitable exchange-based bronze hmo may include a much smaller selection of health care providers and hospitals than Company B’s. network associated with economic bronze advantage b hmo company private market.
- example: company c offers the silver primo ppo+ plan on the private market and the standard silver primo ppo plan on a government exchange, rates may vary. If Company C offers its Silver Primo+ PPO plan on and off a government exchange, you can expect these identical plans to have identical rates.
Also, carriers are not required to offer all metal plans. That means company A may only offer a bronze plan through your state’s exchange, while offering a variety of metal levels on health insurance websites.
Also, plan availability may vary by region. Company A’s bronze plan may be available only in one county and may also be the only bronze option in that region. meanwhile, residents of a large city can choose from several bronze plans.
The easiest way to see your widest range of options is to call an agent or check your zip code online.
2. provider networks
Another important difference that can occur between plans in and out of government markets is variations in your network. One way health insurance companies reduce obamacare switch premium rates is by covering only small or “narrow” physician networks.
Keep this in mind and carefully compare plan networks from the same company. you’ll want to make sure in-network options meet your personal preferences and are conveniently located.
3. participating carriers
trader options also vary on and off government exchanges. Some health insurance companies may be licensed to sell plans in your state, but only on a private website. other companies can only sell exchange-based health insurance (which can still be listed on private websites, for the same price). and some companies may offer health insurance plans on an exchange as well as on the private market.
In-Market and Non-Market Health Insurance: Costs
If the exact same health insurance plan is sold in multiple places, that plan must be offered at the same price everywhere. Otherwise, different plans will have different rates.
Under the Affordable Care Act, rates for all plans cannot vary based on your health history or gender. however, they may vary based on your age, location, and tobacco use.
Few detailed and fair comparisons of on- and off-exchange health insurance premium rates have been made. An analysis of 10 states in the month before the obamacare exchanges opened found that 9 of the insurers that sell only health plans outside of the exchange averaged 23 percent lower premiums than other plans in their state.
get discounts here: if you qualify for an income-based premium tax credit or cost-sharing subsidy, you can get that discount by registering on any website. however, only government-listed health insurance plans are eligible for financial assistance. plans that are exclusively out-of-market do not qualify for subsidy assistance at this time.