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Affordable Care Act: Off-Exchange Plans?

August 02, 2013

By Ray Wilson+

As of January 1, 2014 the Affordable Care Act’s individual mandate goes into full effect, however it is still unclear whether plans sold outside of the exchange will only be the new metal plans.

Affordable Care Act: Off Exchange Plans?

On and Off Exchange Plans

A lot of people, including the operators at the federal marketplace, are unclear of the difference between an on and off-exchange plan. The difference is a little confusing, even to us.

On-Exchange Plans
On-exchange plans are called the Bronze Plan, Silver Plan, Gold Plan, and Platinum Plan. These state or federal exchange plans can be purchased through brokers, agents, providers, and the new navigators hired to help people learn about plans (however, navigators cannot make suggestions about plans), and the benefit of these plans are for those that qualify for ObamaCare cost-sharing subsidies and/or ObamaCare premium subsidies -to help with deductibles, coinsurance, and copays, and premiums, respectively.

Off-Exchange Plans
Off-exchange plans are purchased through brokers, agents, and providers, as well. However, these plans do not qualify for subsidies and are not on the actual federal or individual state exchanges. So the question is whether or not these plans are also “metal” plans. According to Aetna, “Both on and off exchange, health insurance plans for individuals and small group markets will now be assigned a metallic level. The level is based on the how much of the total health care cost the plan pays, versus what the member will pay out-of-pocket.” However, when speaking with agents at other insurance companies there is conflicting information from Aetna, saying that plans being offered after 2014 will not be metallic plans.

We will have to wait and see what happens as it gets closer to the October 1, 2013 enrollment date, to see if off-exchange plans offered by providers will be the same or different from the new metal plans. It is important to note that there are many plans being offered now by insurance companies that continue through the end of 2014. This allows for people to sign up now and see how the new ObamaCare plans work without committing. If you have any questions about plans available now call 800-930-7956 or contact Medicoverage.

The next open enrollment for new health coverage begins October 15, 2015. Applications must be submitted before December 7, 2015 to start a plan in 2016. If you are looking to get covered in 2015 you still have a few options. See link below:

Click here to learn how to get covered in 2015 if you missed the Obamacare 2/15 deadline.

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