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When the Affordable Care Act’s first Obamacare open-enrollment period commenced Oct. 1, 2013, consumers were introduced to state-based and federally facilitated health insurance exchanges known as the Health Insurance Marketplace.
Consumers in all 50 states and the District of Columbia may purchase individual major medical plans through the Health Insurance Marketplace; however, it is not the only place to buy them. Major medical health insurance is also available outside the government-run exchanges in the private marketplace.
Before you shop for your next health plan, be aware of similarities and differences between the on- and off-exchange shopping experiences.
First, let’s look at how they are the same.
All major medical plans sold through Obamacare’s Health Insurance Marketplace and in the private marketplace qualify as minimum essential coverage that fulfills the ACA’s shared responsibility provision.
No matter where they are sold, these plans must also include all of the Affordable Care Act’s consumer protections and benefits, such as1:
Furthermore, your rate can only be determined by the following five factors2:
Now, let’s look at the differences between plans sold through the Health Insurance Marketplace and those sold in the private marketplace.
It comes down to two key factors:
The major medical insurance you buy from the Health Insurance Marketplace:
The major medical insurance you buy in the private marketplace:
It is also worth noting that not all insurance companies sell through the Health Insurance Exchange, and those that do may offer different plan types on and away from it. You can expand your selection by shopping both the private marketplace and Health Insurance Marketplace.
The answer will vary by household.
You can see that one marketplace is not necessarily better than the other. Personal circumstances and preferences will play a role in determining where to buy your next health insurance plan.
To determine which route is best for you:
If you decide to buy major medical insurance outside the Health Insurance Marketplace, you can purchase it:
A health insurance producer (i.e., agent or broker) can familiarize you with your options on and away from the Health Insurance Marketplace, help you assess which plans are a strong match, and discuss with you supplemental plans to round out your coverage.
If you shop the Health Insurance Marketplace, you have access to exchange-based helpers, which include agents and brokers, in-person assisters and call center personnel.
Whether you buy your major medical plan on or away from the Health Insurance Marketplace, you should consider buying dental insurance and can buy a plan in the private marketplace—most health insurance exchanges do not offer dental insurance plans for adults.
Get a quick dental insurance quote at healthedeals.com. While you are there, consider other supplemental coverage such as telemedicine, critical illness and gap plans. These products complement your major medical plan and can help reduce your out-of-pocket healthcare spending.
Have questions? Call the number on your screen to speak with a producer.
This article was originally posted October 5, 2015.
1 U.S. Department of Health & Human Services. “Key Features of the Affordable Care Act.” Last reviewed Aug. 13, 2015. http://www.hhs.gov/healthcare/facts/timeline/timeline-text.html
2 HealthCare.gov. “How Marketplace Plans Set Your Health Insurance Premiums.” https://www.healthcare.gov/lower-costs/how-plans-set-your-premiums/
3 Magan, Dan. “Obamacare Health Plans: Enough Doctor Choice?” CNBC. July 16, 2015. http://www.cnbc.com/2015/07/16/obamacare-plans-offer-narrow-health-provider-options-study.html