As you probably knew already, Obamacare (the Affordable Care Act) makes it compulsory for most citizens of the United States to enroll in a health insurance plan – otherwise, you risk facing very harsh penalties. While most people buy health insurance plans through online health care exchanges run by the government, it is also possible to buy non marketplace health insurance plans – outside of the government exchange in your state of residence.
You might be wondering which option would be better for you – buying health insurance from government-run health insurance marketplace or buying it outside the official marketplace. Unless you qualify for subsidies (in which case you might be enticed by the prospect of getting tax credits as subsidy), there are a couple of good reasons why you should consider non marketplace health insurance.
Some of the benefits of non marketplace health insurance you should note are the availability of more options (greater choice), higher number of health insurance providers, availability of more plans, greater choice for deductibles, and wider drug coverage. We discuss these benefits in some detail, to help you understand and make a better decision on whether to buy non marketplace health insurance.
Availability of More Options
Everyone likes to be spoiled for choice, as having many options to choose from gives you the liberty to decide the best fit for you. This is one of the best advantages of non marketplace health insurance. When you’re buying an off exchange health insurance plan, you open up a greater amount of options beyond the offerings available on the government exchanges.
For example, while Obamacare makes it mandatory for all health insurance plans -both inside and outside the exchanges – to offer 10 compulsory benefits, you can get other unique benefits tailored to your specific needs when you’re shopping for plans outside the exchange. In this regard, non marketplace health insurance allows you to better customize the policy benefits to suit your specific requirements.
More Health Insurance Providers in the Off Exchange Network
Health insurance companies in the official government exchanges often limit their provider networks for exchange plans in order to control their costs. This is not the case of the exchange where the network of health care providers is much more extensive. Shopping for a non marketplace health insurance plan will enable you to request an agent to review all available options, thus opening up many different plans to choose from.
What this means is that if you have a serious health condition or you gave a preferred specialist assisting you with that condition, you may consider it important to have your hospital or doctor included in the health plan or network you choose. This is often not possible with plans in the official government exchanges, whereas non marketplace health insurance plans make this possible by giving you access to much larger provider networks.
Greater Choice Over Health Insurance Deductibles
Deductibles refer to the initial amount you’re required to pay out of the pocket before your health insurance plan starts to pay. This aspect is one area where non marketplace health insurance is more beneficial than exchanges, because it gives you a greater choice with regard to how much you can pay and how you choose to pay.
There’s a great variation in deductibles at the different tiers of health plans available on exchanges and off the marketplace. When deciding on the right plan, you typically need to consider the monthly premiums as well as the deductibles.
People who use multiple health services and settle for a health insurance plan which has lower monthly premiums and a high deductible could end up paying significantly more out of pocket than they originally expected. Buying non marketplace insurance makes this process easier, as the wide array of options makes it easier to determine the best that suits your deductibles and payment plans.
Non Marketplace Health Insurance Offers More Health Plans
The sad truth about government-run health insurance exchanges is that some health plans are simply not available as the exchanges do not include every category of health insurance. This can be frustrating for people with more exact needs.
For instance, exchanges do not offer short-term medical insurance as well as long-term care insurance. Besides, certain health insurance companies voluntarily choose not to participate in some marketplaces, meaning that people who prefer such companies must go off the exchanges to buy plans from them.
Wider Drug Coverage
Many people consider drug coverage as a major factor when choosing a health plan, and in this context, non marketplace health insurance is the clear winner. Health plans may limit the drugs covered in the same way that provider networks do, or they may choose to reimburse more for generic drugs than for brand-name medications.
What this means is that people with a health condition for which they have been using a specific drug may find that their drug is not covered under the plan they want to enroll for in the exchange.
The chances of seeing your preferred drugs covered by your plan are much higher when you use non marketplace health insurance, as there is a high number of providers and networks, which translates to wider drug coverage.
You can take your time to shop around for plans until you find one that covers the drugs you rely on for treating the specific health condition you have. However, it is important to bear in mind that the limit on out of pocket expenses may not apply to medications that are not on the health plan’s list of covered drugs.
The Bottom Line about Non Marketplace Health Insurance
Although many people seem not to realize the potential in buying plans from outside the official exchanges, the bottom line is that non marketplace health insurance offers very useful benefits and is certainly worth considering.
However, if you decide to buy a health insurance plan off the exchanges, you must make sure to shop for your preferred plan before the end of the enrollment period. Once the enrollment period is over, you would only be able to shop for plans during a special enrollment period activated if you have a qualifying life event (e.g. getting married or losing your job).