Should you look outside the ACA’s exchanges?

One of the main provisions of the ACA was to revise the market for individual health insurance . The law abolished medical underwriting bonuses based on gender, and short-term policies with an exorbitant personal coverage and it reduced the premium gap between insured younger and older. The maximum annual benefits and lifetime were abolished for all essential health benefits .

The purchase of an individual market policy is now a realistic option for many more people. And the ACA health insurance scholarship (marketplaces) in every state makes it easy to compare policies, sign up for a plan, and receive a grant if you qualify.

But this is not the only option. Although much of the media attention on individual health insurance is often focused on exchanges, individual health insurance policies are also available off-exchange in all states (but not in the District of Columbia ), and may be a good choice for some consumers.

An over-the-counter plan is only a health insurance policy purchased directly from the carrier or through an agent or agent. a broker, outside the official health insurance district created by the ACA. The registration data for over-the-counter regimes are not followed as closely as the listings data, but an analysis by Mark Farrah Associates estimated in July 2017 that OTC listings were about 5 , 4 million people.

It is important to note that over-the-counter plans are not available in the District of Columbia . Regulators determined that coverage would only be available through the exchange. In Vermont off-exchange plans were not available in 2014 or 2015, but " complete individual direct registration " (ie, Off-Exchange) became available in Vermont in 2016.

In exchange for off-exchange

The consumer protections under Obamacare apply to all major medical policies, regardless of whether the coverage is sold in the stock market. In addition to the basic requirements that all policies must now adhere to, plans sold in constituencies must also be certified Qualified Health Plans (QHP).

QHP certification is granted by scholarships, and may vary from state to state. Exchanges can define QHP requirements that go beyond the basic guidelines of the ACA. (Pages 33-38 of this HHS memory are useful for understanding this.)

Although all plans sold on the individual market – on or off the stock exchange – must meet the requirements of the ACA, the QPP may be required to comply with additional standards which vary from state to state. QHPs in all states must offer at least one gold plan, a plan of money and a child only plan (for 2018, this rule was tight up requiring issuers of QHP to offer A Gold Plan and a Silver Plan in each area where they offer currency hedging, they will not be allowed, for example, to offer a Silver Plan and Plan Gold in limited areas within a state, and then only offer Bronze plans in other areas of the state)

QHPs may also be sold off the market. Some carriers choose to sell their [QPS] certified both in exchange and off-exchange (with all registrants in the same pool for risk-sharing purposes) – but over-the-counter contracts must not be QHP certified.

These are still good quality projects – Swiss cheese coverage days are over, no matter how the fonts are purchased. And off-exchange plans are guaranteed regardless of medical history, just as policies in trade. The same open registration dates apply outside of the exchange, and most of the rules of special registration period s & # 39; 39 also apply to plans purchased off the exchange.

To register … or not … in an ACA exchange

The exchange is the best option for people who qualify for bonuses and cost-sharing grants since grants are only available for plans purchased in the stock exchanges. In October 2016, HHS estimated that there were 2.5 million people benefiting from over-the-counter coverage and who would be eligible for subsidies if they moved instead. Some of these people might be aware of stock exchange grants, but may have opted for off-plan plans for reasons other than cost. But it is also likely that many of these people are unaware of how much less they could pay for premiums when they switched to the exchange.

It is also important to note that if you start the year with income that is not eligible for the grant and your income falls during the year to a level that you would qualify for a grant, you could not start getting a grant at that time if you were already enrolled in an exchange program. If you renew your over-the-counter plan or opt for an over-the-counter plan during open enrollment you will not be able to switch to a qualifying exchange program until the next open enrollment, no matter what income changes in the middle of the year (a qualifying event would allow you to change plans, but a change in income is not an eligible event if you do not have are not already listed on the stock exchange).

But what if you are not eligible for a grant (and you are fairly certain that this will continue to be the case all year round), or prefer you simply avoid the exchange? Whatever the reason, if you want to get coverage outside of the exchange, you still have access to ACA qualified health insurance policies.

"Proxy Direct Enrollment" is an IPO

As of registration in 2018, HHS established a " direct proxy entry " which will allow third parties (online insurance brokers) to guide consumers through the registration process via the third party website, without having to come and go to at the time. The new process is an improvement on the current direct inscription path, and Tim Jost describes it here in more detail. ]

If you work with a web broker who uses the direct proxy route, you must first create your own account on; Your web broker can not do it on your behalf. Then you will complete the registration process on your online broker's website, including determining eligibility for premium subsidies and cost-sharing grants.

This type of registration is still considered "online" because the information you provide on the web broker's site will be transmitted to (the system that HHS has created is only applicable to states that use; state-run exchanges that use their own registration platforms should establish their own direct registration channels if they wished).

If you are working with a web broker and you do not know how your registration is handled, ask questions. If you do not create an account with the exchange and you are asked if you want to determine your eligibility for premium grants, you probably register off-exchange. But if you create a account and go through the process of determining the premium eligibility, your web broker will likely use the direct proxy route for 2018, and your listing will go public. .

The use of a broker does not mean that you are leaving in exchange. Brokers can assist you in the registration process directly through the exchange, or they can help you to complete your Exchange Registration (in a using the credit line. proxy direct registration. If you call one of the partners of at 1-855-367-0132 you will be in contact with an accredited and accredited broker who can enroll you in a plan compliant with the law. ACA, on or off exchange – the choice is yours.

Plan design, price may vary

If the same policy is sold on the stock market and off-exchange, the price will be the same. Some carriers choose to sell identical plans both inside and outside the stock market. For these plans, the premium will not vary, whether it is in the stock market or over-the-counter (of course, if you qualify for a grant, the price after subsidy will be lower in riding).

But operators can choose to offer different models or networks of plans for their trading plans and off-exchange plans. If a carrier offers off-the-shelf plans that are different from the plans that it offers inside the stock market, the price will also be different – although all of the carrier's members will be in. a single risk pool.

Some carriers offer only plans outside of the exchange, so you will have to shop off-market to see their plans. In some states, the "best" coverage is off-exchange, in others, it's about the exchange.

In some states, the cheapest plan is off the stock market, and in others, it is on the exchange. There is no single answer that applies everywhere, whether it is an exchange plan or an over-the-counter plan.

If you want to shop off the stock market, you can buy a policy directly from a health insurance company or from an agent or broker. the price will be the same anyway. Even if you know that you will not be eligible for any grants in the exchange, you will want to consider exchange options as well as off-exchange plans to find the policy that best suits your needs.

Brokers who are authorized to sell foreign exchange contracts should be able to provide you with exchange and exchange options, in one place. Know that the open registration window for individual health insurance applies both on and off the stock market. For the 2017 coverage, the open enrollment window continues until January 31, 2017. After that, you will have to wait until 2018 to have coverage, unless you have a qualifying event .

If you qualify for a grant stay with the exchange. But if you do not, take your time, compare all the options, and ask for the policy that best suits your situation. Do not consider politically motivated advice from people who have a direct interest in directing you to or from the exchange.

ACA has improved the quality of coverage in the individual market and has also expanded the options that are available to many people through guaranteed emissions coverage and subsidies. Although exchanges are a highly publicized part of the ACA, the improvements brought by the law also extend to off-exchange plans. Consumers can be confident no matter what option they choose.

Plans that are not a major medical coverage are not regulated by the ACA

Since some types of coverage are not regulated under the CCA, a caution is required here.

All major health insurance plans whose effective date is January 1, 2014 or later must be in accordance with the ACL. It is true that they are sold on the exchange or over-the-counter.

But there are a variety of types of coverage that are not regulated by the ACA. They include limited benefit plans, short-term coverage reduction plans, accident supplements and critical illness insurance plans .

These plans are sold outside the stock exchanges, but they are not what we are talking about when we say "off-market plans". They are not what people think of as "real" health insurance, and they do not make it comply with the regulations established in the ACA. In general (with the exception of short-term health insurance to fill a short period of coverage), they are not designed to serve as a standalone cover. And in most cases, relying solely on them for your health coverage will not only leave you severely underinsured, but also face a penalty when you file your taxes.


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