Key Difference Between On and Off- Health Insurance Marketplace

On and Off Health Insurance Marketplace

The health insurance Marketplace was created by the Affordable Care Act to allow individuals and businesses a platform to shop, compare, and buy health insurance plans. This Marketplace began its operation on January 1, 2014, and it provides detailed information on different health insurance plans to help people better understand their options. Operated either by a government agency like the Department of Health and Human Services or a nonprofit organization, Marketplaces offer a choice of different health plans to help people  buy the best and affordable health plan. Every state was supposed to set up own Marketplaces for the individual and small business markets and for the states who didn’t create their Marketplaces, the federal government did for them. Wisconsin did not create its Marketplace so the residents of the state use a federally-facilitated Marketplace. People also have other ways of obtaining coverage like through an employer or from a private insurer. Marketplace coexists with these traditional means of obtaining coverage as an option that promotes competition and simplifies the health insurance buying process.

Key Difference

People while shopping for health insurance plans can find about all the health insurance options available in their area from both on and off Marketplaces. To find about the health plans available in their area on the health insurance Marketplace, people will need to provide the ZIP code of their area and the Marketplace will then display information in a standard format that will allow people to easily compare between plans and their benefits. Besides Marketplace, people also have the option of obtaining health insurance through off-Marketplace like through an agent, directly from a health insurance company. While shopping for health insurance in a Marketplace, people have the option to enroll in a health plan either online, in person, by phone, or by mail.

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Health insurance plans and the enrollment options are similar irrespective of whether people buy health insurance from the Marketplace, a health insurer, or an agent. The big difference is that when people buy a health plan on the Marketplace, then if eligible they will get subsidies or financial assistance such as individual premium tax credits, cost-sharing reductions, and coverage exemptions that could help them pay for the premium. The option to save money is the best thing of enrolling in a Marketplace health plan.

Qualified Health Plans

Every health insurance plan available on the Marketplace must meet a certain set of standards and should be certified as a qualifying health plan according to the Affordable Care Act. For instance, every health plan sold on Marketplace provides coverage for ten essential health benefits that are determined by the Department of Health and Human Services. Even the off-Marketplace plans have to meet these standards. Only certain employer-sponsored group health plans and short-term health plans are exempted from offering essential health benefits. The essential health benefits include preventive and wellness services, maternity and newborn care, chronic disease management, laboratory services, pediatric services, emergency services, rehabilitative services, and more.

Health Insurance Coverage

No matter whether people shop through Marketplace or off the Marketplace, the main thing is to have  proper health insurance. Having proper health insurance coverage is vital, as this will help people prevent financial disaster. Any medical emergency can wipe out people’s bank balance very  quickly, so they should sign up for a health plan during the open enrollment period that runs from November 1 to December 15 in the majority of the states. Missing health insurance or avoiding to have health insurance is not at all a wise decision, as people can get financially drained in case of some medical emergency.

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Shopping On-exchange or Off-Exchange

People should shop for health insurance plans on-exchange in the following circumstances:

  • If they think that they will qualify for a government subsidy.
  • If they are comfortable with a less number of in-network doctors.
  • If people wish to have financial assistance in paying for healthcare.
  • If they don’t qualify for Medicaid and find difficulty in paying the full price of the private health insurance plan.

People should shop for the off-exchange plan in the following cases:

  • If they earn too much to qualify for a government subsidy.
  • If their preferred doctor doesn’t accept any on-exchange health plan and they often see their preferred doctors that they want their visits covered under their health plans.

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