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Anthony Lee
Anthony Lee

Buying Health Insurance Not On Exchange



While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.




buying health insurance not on exchange



If you buy your health insurance on the individual marketplace, there are basically two kinds of polices you can consider for yourself and your family: on-exchange policies and off-exchange policies. Each option has its own unique benefits that should be considered the next time you are ready to shop. Read on to learn the differences between the two and discover which choice could be the right fit for the coverage you need.


The original health insurance marketplace started as the federal Health Insurance Marketplace - a website where individuals could shop for various health care plans available under the Affordable Care Act (ACA), often referred to in earlier years as Obamacare, beginning in 2010. Since that time, 14 states have developed their own individual health insurance exchanges, aka marketplaces. All medical insurance plans sold on the public marketplace must be ACA-compliant, meaning they must cover 10 essential health benefits for consumers.


Off-exchange health insurance is a plan that is purchased directly from an insurance provider, or through a broker. This is outside of your state's health insurance marketplace or outside of healthcare.gov, aka the exchange. Though these are considered private plans, they also fall all under ACA compliance, which ensures minimum coverage and essential health benefits.


A primary benefit of purchasing health insurance from an insurance provider is that you have a more first-hand expertise with the plans they offer and they can break down even more details and differences in their offerings. Sometimes, insurance providers may offer more options than their plans that are available on the exchange. Additionally, you can enjoy the simplicity of direct enrollment with an agent rather than a less direct online portal that connects with the insurance company.


Yes, you can buy health insurance outside the marketplace. Most insurance companies that offer health plans through the marketplace also offer policies outside the exchange. Even if you purchase a health plan outside the marketplace, the cost of the insurance plan will remain the same as it is for people purchasing health plans on exchange.


One of the main objectives of the health insurance marketplace is to make health plans more affordable and accessible to people. However, health plans purchased outside the marketplace may also offer the same benefits.


Another reason to shop for your health insurance off-exchange is the network of healthcare providers included in the plan. In some cases, health insurance companies control their costs by limiting the provider networks for exchange plans.


A HealthPocket study showed a great variation in deductibles of the different tiers of plans available on and off exchanges. When deciding on a plan, you have to consider not only the monthly premiums but also the deductibles, Coleman says. If you use a lot of health services and choose a plan with lower monthly premiums but a high deductible, you could end up paying much more out of pocket than you planned.


You may find you have more options when it comes to drug coverage if you shop off exchange. Like provider networks, health plans can limit the drugs that are covered, reimburse more for generics than brand names, or reimburse more for drugs you purchase via mail-order rather than from your local pharmacy.


Some health insurance companies have opted not to participate in the ACA marketplace. If you prefer these companies for your health coverage, you will have to buy plans from them outside the marketplace.


Open enrollment is the period within the year that people can enroll in a health insurance plan. Open enrollment for the Health Insurance Marketplace runs annually from early November to mid-December, with coverage starting in the New Year. In 2021, You can enroll in Marketplace health coverage February 15 through May 15 due to the coronavirus disease 2019 (COVID-19) emergency.


The individual health insurance market has changed a lot in recent years thanks to the passage of the Affordable Care Act (ACA), which is more popularly known as ObamaCare. In fact, many people who get insurance on the individual market now buy coverage through state exchanges or through federal exchanges.


Healthcare.gov is the federal exchange, which serves the majority of states. California, Colorado, Connecticut, Washington D.C., Idaho, Maryland, Massachusetts, Minnesota, New York, Rhode Island, Vermont, and Washington each have their own health insurance exchanges.


These insurance subsidies cap your spending on premiums at a specific percentage of your income. So you may be giving up free money that makes health insurance more affordable if you bought an on-exchange plan.


If you purchased health care insurance through the Marketplace, you should receive a Form 1095-A, Health Insurance Marketplace Statement, at the beginning of the tax filing season. The information shown on Form 1095-A helps you complete your federal individual income tax return. If Form 1095-A shows coverage for you and everyone in your family for the entire year, check the full-year coverage box on your tax return. Among other things, Form 1095-A reports the total monthly health insurance premiums paid to the insurance company you selected through the Marketplace. It lists the amount of premium assistance you received in the form of advance payments of the premium tax credit that were paid directly to your insurance company, if any. If you received a Form 1095-A with incorrect information, see our Corrected, Incorrect or Voided Forms 1095-A questions and answers to find out how it affects your taxes.


If advance payments of the premium tax credit were paid on behalf of you or an individual in your family, and you do not file a tax return reconciling those payments, you will not be eligible for advance payments of the premium tax credit or cost-sharing reductions to help pay for your Marketplace health insurance coverage in the next year. This means you will be responsible for the full cost of your monthly premiums and all covered services. In addition, we may contact you to pay back some or all of the advance payments of the premium tax credit.


In all, about 2 million more people would obtain individually purchased coverage under this option than under current law, CBO estimates, and about 2 million fewer people would have employment-based coverage in each year. Small employers offering health insurance to their workers would be more likely to obtain it through the exchanges than they would under current law. The option would have minimal effects on the number of people with other sources of coverage and on the number of people who would be uninsured.


One rationale for adding a public plan to the exchanges is that it would help reduce premiums for some individuals, families, and employers who would buy insurance through the exchanges but would not qualify for subsidies. Premiums would be reduced both because the public plan would be one of the lowest-cost plans available in many areas and because adding a low-cost option would increase the competitive pressure on private plans, leading them to decrease their premiums.


Individual health insurance is one of several health coverage options for Washington residents. Most Washington residents get health insurance through an employer or government source instead. If you have other coverage options, you may not need to buy individual insurance. For example:


Seeing a doctor or filling a prescription at a pharmacy can be very expensive. When you buy health insurance, you agree to pay a monthly premium, and in return, the insurance company agrees to pay part of the cost of your medical bills for covered benefits.


Not every health insurance plan helps you pay your bills in exactly the same way. There are differences between plans that affect how much you will need to pay for your health care, and it is important to keep track of each of them when comparing plans. These include monthly premiums, cost-sharing when you get services, and out-of-network charges). Here are some considerations:


When you buy health insurance you will need to pay premiums each month to keep your coverage. The premiums need to be paid monthly, before the month you want coverage, regardless of whether you use the insurance or not. In general, the higher the monthly premium for a plan, the lower the average cost-sharing when you access care.


This is one of several explainers to help consumers navigate their health insurance choices under the Affordable Care Act, or as some call it, Obamacare. Click here for answers to other common questions. Have a question we missed? Send it to health@npr.org. We may use it in a future on-air or online segment.


It's an online marketplace where individuals and small employers can shop for insurance coverage. Enrollment began Oct. 1 for policies that will go into effect on Jan. 1. The exchanges will also help people find out if they are eligible for federal subsidies to help cover the cost of coverage or if they are eligible for Medicaid, the federal-state health insurance program for the poor.


You can enroll until March 31, 2014, though you'll need to sign up and pay your first premium by Dec. 15 of this year if you want to be covered when the mandate to carry health insurance kicks in on Jan. 1. If you sign up and pay premium between Dec. 16 and Jan. 15, 2014 - coverage starts on February 1.


Yes. Sixteen states and the District of Columbia are running their own exchanges and the federal government is setting them up in 27 states. In seven states, federal and state officials are partnering to run the exchanges. You can get information about the exchange at healthcare.gov, which has details on the federal exchanges and links to state-run exchanges. 041b061a72


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