On-Exchange vs. Off-Exchange ACA Marketplace Plans

SOURCE: UnitedHealthcare

If you’re familiar with Affordable Care Act (ACA) Marketplace plans, you may already know how they work. ACA Marketplace plans are health care plans that people can buy on their own, rather than through an employer or another government-run program, like Medicare or Medicaid. But do you know the difference between an on-exchange plan and an off-exchange plan? Read on to learn which choice could be the right fit for the coverage you need.

On-exchange: subsidy smart

On-exchange plans are plans that you purchase through the health insurance Marketplace. These plans are ACA-compliant, meaning they must cover 10 essential health benefits for consumers. If you’re shopping on-exchange plans, you may be eligible for financial help in the form of monthly premium subsidies (savings) and cost-sharing reductions. These can significantly lower the amount you pay each month to have health insurance and your out-of-pocket costs when you receive care, making your health insurance coverage more affordable.

Off-exchange: more options

Off-exchange plans are health insurance plans you buy directly from an insurance company or broker, outside of the health insurance Marketplace. Off-exchange plans still fall under ACA compliance, providing minimum coverage and essential health benefits, but may offer more flexibility in coverage options. One of the biggest differences with an off-exchange plan is that you won’t be eligible for the premium subsidies and cost-sharing reductions available with the on-exchange plans. 

When do off-exchange plans make sense?

Here’s when off-exchange plans might be a good fit:

  • You’re a high earner: If your income disqualifies you from Marketplace subsidies, off-exchange plans could offer comparable coverage (without the subsidy factored in) at a potentially lower premium. 
  • Your employer offers reimbursement: Individual coverage health reimbursement arrangements (ICHRA) and qualified small employer health reimbursement arrangements (QSEHRA) allow employers to reimburse their employees for some or all the premiums employees pay for health insurance they purchase on their own. Most people who are offered ICHRAs or QSEHRAs will not qualify for subsidies and will likely need to shop off-exchange plans. 
  • You’re seeking specific plans: Shopping off-exchange plans can offer a wider variety of options for those looking for different plans. Just be sure to consider factors like network coverage, premiums, deductibles and out-of-pocket costs.

Here are some of the carriers active in the Texas market:

ON EXCHANGE

  1. Ambetter
  2. Baylor Scott and White Health Plan
  3. Blue Cross Blue Shield of Texas
  4. CHRISTUS Health Plan
  5. Cigna Healthcare of Texas, Inc.
  6. Community First
  7. Community Health Choice
  8. Imperial Insurance Companies, Inc.
  9. Moda Health Plan, Inc.
  10. Molina
  11. Oscar
  12. Sendero Health Plans, Local Nonprofit
  13. UnitedHealthcare
  14. UnitedHealthcare of Texas
  15. WellPoint

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OFF EXCHANGE

  1. Ambetter
  2. Baylor Scott and White Health Plan
  3. Blue Cross Blue Shield of Texas
  4. CHRISTUS Health Plan
  5. Cigna Healthcare of Texas, Inc.
  6. Community First
  7. Community Health Choice
  8. Imperial Insurance Companies, Inc.
  9. Moda Health Plan, Inc.
  10. Molina
  11. Oscar
  12. Sendero Health Plans, Local Nonprofit
  13. UnitedHealthcare of Texas
  14. WellPoint