Shopping for Health Insurance Outside of the Health Insurance Marketplace

If you make too much for cost assistance, or want to see your private health plan options, you may want to shop outside of the Health Insurance Marketplace. Let’s cover why someone would want to shop around for Quotes Outside Of The Marketplace, what your options are, and how getting covered outside of the marketplace works.

TIP: You can use a private health insurance broker to help you enroll in a marketplace plan and you can also go direct to an insurer for assistance. You can also enroll in a plan not offered on the marketplace through some brokers and insurers. This means shoppers have options, but also complexities to consider. We always suggest starting your journey at HealthCare.Gov to get a better sense of your options, but the choice is ultimately in the hands of the shopper. When choosing an outside source, consider sticking with local in-person agents and brokers, major insurers, and well known online brokers and make sure you purchase minimum essential coverage.

FACT: All qualified major medical plans sold inside and outside of the marketplace have the same basic regulations, offer the same basic benefits, rights, and protections, count as minimum essential coverage, and will protect you from the per month fee for not having coverage.  The main differences you’ll find in plans are costs and benefits beyond the minimum standards.

Only Marketplace plans offer cost assistance, but for those making more than 400% FPL shopping for quotes outside of the marketplace may make sense.

Open Enrollment Outside the Marketplace

The first thing to note about Enrolling In A Major Medical Plan through the individual market is that you still need to enroll in coverage during open enrollment.  Since 2014 all private insurers in the individual market have adopted ObamaCare’s open enrollment period.

Outside of open enrollment, most of the plans you’ll find outside of the marketplace are short term plans.  These won’t count as minimum essential coverage and won’t protect you from the fee.

Why Shop Outside of the Marketplace for Coverage?

There are a few good reasons to shop around for quotes outside of the marketplace.  Let’s cover those now:

  • You don’t make enough for cost assistance (for 2017 that is more than $47,520 as an individual or $97,200 as a family of 4).  Cost assistance is only available in the marketplace, but even if you don’t make enough for cost assistance in the marketplace, you can use it as a plan comparison and enrollment tool.
  • You want access to a wider array of plans.  Since not every plan in your region will be sold on the marketplace, you’ll need to shop outside of the marketplace to get access to every plan in your region.  There is no one provider or broker who will have every health plan in your region.  You’ll need to shop around to see what is out there.

Will I Pay More For a Health Plan Outside of the Marketplace?

Without taking cost assistance into account, you’ll never pay more for a specific plan in a specific region regardless of how you shop.  Prices are tightly regulated, and prices of plans cannot be changed based on factors like commissions.  Broker and agent commissions are paid for directly by the insurer out of a pool.  If you go directly to an insurer, the insurer keeps the commission.

The only things that affect the price of your health plan are: what plan you get, your location, your age, your family size, your income (if you are eligible for cost assistance subsidies), and factors like employer contributions.  Your health or where you shop won’t affect the price of a specific plan.

FACT: You’ll never pay more for the same plan in the same region, before cost assistance, regardless of where you buy it.

Should I Shop for Health Quotes Outside of the Marketplace?

The more money you make, the more viable Shopping outside the marketplace becomes.  If you just barely qualify for cost assistance you may want to understand all of your options. Chances are you’ll still pick a marketplace plan as even the most expensive subsidized plan is substantially cheaper than an unsubsidized one.  That being said, healthcare costs go beyond premiums, the more medical services you plan to use in a year, the more sense it will make for you to shop around and see all of your options.  You’ll never be locked into a plan until you enroll, and under the ACA switching plans is pretty painless if done during open enrollment. Once open enrollment is over you’ll be locked into your plan until the next open enrollment period.

As a rule of thumb, the more cost assistance you are eligible for, the less sense it makes to shop anywhere except your state’s Health Insurance Marketplace.

How to Buy Private Health Plans Outside the Marketplace

If you don’t qualify for lower costs based on your income, you can get coverage 4 ways according to HealthCare.gov:

  • Directly from an insurer. You can contact any health insurance company and see plans available in your area. Many have websites that let you compare all plans available from that company. You can take a look at the advertisers on our site or use the HealthCare.Gov plan Finder website, which presents information about private health plans available outside the Marketplace.
  • With the help of an insurance agent or broker. Agents usually work for a single health insurance company. Brokers generally sell plans from a number of companies. They can help you compare plans based on features and price and complete your enrollment. You don’t pay more to use an agent or broker. They’re generally paid by the insurance company whose plans they sell.
  • From an online health insurance seller. These online services offer health plans from a number of insurance companies. They let you compare prices and features and then enroll with the insurance company.
  • Through the Health Insurance Marketplace. You can apply and enroll through the Marketplace whether or not you qualify for lower costs based on your income.

Do I Have to Use the Marketplace To Get a Marketplace Plan?

The only way to get a marketplace plan or cost assistance is through your state’s Health Insurance Marketplace.  That being said, some major brokers and providers can help you find out if you qualify for subsidies and some can help you enroll in a marketplace plan.  So in some cases, you have your choice between getting help from your state’s marketplace or an outside broker or agent.  The benefit to choosing an agent outside the marketplace is that they can present other non-marketplace plan options too.

The Bottom Line on Off-Marketplace Health Plans

In summary shopping around for quotes on health plans is a smart move every open enrollment.  The more you understand what the private insurance market offers, the better your chances of finding the best plan for you.  If you qualify for cost assistance, your best choice will almost always be a subsidized marketplace plan.