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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 at the top of 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
This document is for general informational purposes only. While we have attempted to provide current and accurate information, this information is provided "as is" and we make no representations or warranties regarding its accuracy or completeness. The information provided should not be construed as legal or tax advice or as a recommendation of any kind. External users should seek professional advice from their own attorneys and tax and benefit plan advisers with respect to their individual circumstances and needs.
THIS PLAN DOES NOT MEET MINIMAL ESSENTIAL COVERAGE REQUIREMENTS FOR PEDIATRIC DENTAL SERVICES IN ACCORDANCE WITH THE AFFORDABLE CARE ACT (ACA) PROVISIONS.
About The IHC Group
Independence Holding Company (NYSE: IHC) is a holding company that is principally engaged in underwriting, administering and/or distributing group and individual disability, specialty and supplemental health, pet, and life insurance through its subsidiaries since 1980. The IHC Group owns three insurance companies (Standard Security Life Insurance Company of New York, Madison National Life Insurance Company, Inc. and Independence American Insurance Company) and IHC Specialty Benefits, Inc., which is a technology-driven insurance sales and marketing company that creates value for insurance producers, carriers and consumers (both individuals and small businesses) through a suite of proprietary tools and products (including ACA plans and small group medical stop-loss). All products are placed with highly rated carriers.
IHC Specialty Benefits, Inc.
IHC Specialty Benefits, Inc., doing business as Health eDeals Insurance Solutions is a full-service marketing and distribution company that focuses on small employer, individual and consumer products. Health eDeals markets products via general agents online, telebrokerage, advisor centers, private label and directly to consumers. For more information about Health eDeals visit http://www.HealtheDeals.com.