The Affordable Care Act or Obamacare requires most Americans to enroll in a health plan, so many of them buy health plans through the government-run online health care exchanges. However, as a U.S. resident, you must be aware that health insurance exchanges are not the only option to buy plans as you are free to buy health plans outside your state’s exchange also. You may prefer to buy from the exchange if you qualify for the subsidies because if you don’t buy from the exchange then you will not receive any tax credit or subsidy but if you don’t qualify for a subsidy then are free to purchase a plan outside an exchange.
Some of the benefits of purchasing health plans off-exchange
Greater Choice of Plans – The prime reason for you to buy a health plan off-exchange is a greater choice. Every health plan available on your state exchange should be available off the exchange at the same price. However, health insurance companies may offer health plans that are not available through the exchanges. You must be aware that all ACA-plans offer ten essential benefits that are available both inside and outside the exchanges. But if you are looking for benefits beyond the essential coverage, then you can shop off-exchange to find a wide range of choices and opportunities to find a plan that aligns with your healthcare needs.
Extensive Network-of-providers – Another important reason to shop for health plans off-exchange is the extensive network of healthcare providers included in the plan. Health insurance companies in some cases control the cost of the plan by limiting the healthcare provider networks for the plans available through the exchange. For instance, Anthem, a leading insurance company in California does not offer PPO plans on the exchange, rather it offers EPO plans. Thus, if you shop off-exchange and ask your advisors to suggest all available options, then you may have a wide range of plans to choose from each metal level. If you are shopping through the exchange, you may find a plan that looks best to you but might not be having your preferred doctor or hospital in the plan’s network. Besides, some of the EPOs and HMOs plan won’t provide coverage if you go receive care outside of their network, whereas other providers may limit your coverage and it certainly may be less than what you would get if you go to in-network providers. Thus you will benefit from buying off-exchange plans because it will give you access to larger provider networks. If you have some chronic health issues or you prefer to visit a specialist of your choice, then you should make sure to buy an off-exchange plan that includes your choice of doctor and hospital in their network.
Deductibles – Deductibles are the amount which you pay out of pocket before your plans begin to pay, so as an informed consumer you should know that off-exchange plans give you a greater choice as far as deductibles are concerned. Some studies have shown that there is a great variation in deductibles on the different tiers of plans available on or off the exchange. While choosing a plan, you need to consider not only the monthly premiums but also the deductible amount. In case if you avail of a lot of healthcare services but buy a health plan having lower monthly premiums and a high deductible then chances are you will end up paying much from your pocket than you expected. Thus, while comparing health plans on and off-exchange, you need to check every detail, and you will find that off-exchange plans provide you with more deductible options.
More Drug coverage – While shopping for health plans off-exchange, you may find more drug coverage options compared to on-exchange health plans. Just like the healthcare provider networks, on-exchange plans limit the drugs that are covered. On-exchange plans reimburse more for generic drugs than branded drugs or they reimburse more for the drugs that you buy mail-order. Thus, if you use a particular drug, then you should check whether that drug is covered under the plan in which you wish to enroll. However, shopping for off-exchange plans will give you more drug coverage options compared to on-exchange plans.
Some plans are simply not available – Health insurance exchanges don’t provide every category of health plans. For instance, short term plans and long-term care insurance are simply not available on the exchange. In addition to this, health insurance companies like Aetna, and UnitedHealthcare do not participate in some of the states’ exchanges. So if you prefer to from these companies, then you will have to buy plans from outside the exchange. Even if you qualify for a subsidy, it may not be enough to make it worth buying because premium subsidies are calculated on different factors, and the subsidy might not be enough to make it worth a buy from the exchange. Some chances may find a more affordable health plan off-exchange.