As per the Affordable Care Act, Americans are required to enroll in a health insurance plan. Though, most Americans buy health plans through the government-run online health exchange. However, the health insurance exchanges are not the only option and people can buy health insurance outside their state’s exchange. Individuals qualifying for subsidies may be attracted to buy from the exchanges and if their plan is not from the exchange, then they would don’t get tax credits as subsidy. However, others have off-exchange options too.
Greater Choice available at Off Exchanges – The prime reason behind individuals buying off-exchange plans is a greater choice, and every health plan available on exchange in the state must be offered off the exchange at the same price. However, the off-exchange plans are not available in the exchange. Health insurance companies can offer different health plans that are not available through the exchanges. All the ACA-complaint plans available inside and outside the exchange must offer ten essential health benefits. However, individuals who are looking for a specific set of benefits should shop for an off-exchange plan, as they will find a wide range of choices and opportunities to find a plan exactly as per their needs.
More Healthcare Providers in the Network – Individuals prefer shopping for off-exchange plans because off-exchange plans have more healthcare providers in the network. In some cases, health insurance companies control the cost by having a limited number of providers in their networks for exchange plans. Individuals shopping at off-exchange plans may find different plan options and can choose a plan as per their needs. It is often observed that while shopping through the exchange individuals find difficulty in finding a plan that includes their preferred doctor or hospital. Thus, individuals prefer to buy off-exchange plans, as they have different plans to choose at a specific metal level. This becomes more important for people having chronic conditions because they will surely want a plan that includes their preferred doctor and hospital in their plan.
Deductibles – Another prime reason for people shopping for off-exchange plans is that these plans offer greater choice in deductible too. A deductible is an amount which individuals pay out-of-pocket before their plan starts paying. As per a study it was proved that there is a great variation in deductibles in plans of different tiers available off the exchanges. People while shopping for health plans should pay equal focus on both premiums and deductibles. Individuals who use a lot of healthcare services should choose a plan with a low deductible, otherwise they would end up paying much more out of pocket than they expected.
Drug coverage – Drug coverage is another factor that motivates people to shop for off-exchange plans because off-exchange plans come with more drug coverage options. Health plans available on exchange limit the drugs that are covered or reimburse more for generic drugs compared to branded drugs. Individuals who use the specific drug should ensure that those drugs are covered under the plan in which they wish to enroll.
Some Health Plans are Not Available on Exchange – There are very limited health plans available on the exchange, as exchanges do not offer every type and category of the plan. For instance, short-term plans and long-term care plans are not available on exchange and individuals can buy these plans off-exchange only. Besides, some renowned health insurance companies like UnitedHealthcare and Aetna are not participating in exchanges in some marketplaces, so individuals who want to buy health plans from these companies, then they will need to buy from outside the exchange.