Health Insurance
When researching health insurance options, you may read about the terms, “individual market”, “on-exchange”, and “off-exchange”, but what are they? I’m here to help!
On-Exchange Plans
The individual market is made up of individual plans, regardless of where they’re purchased…on-exchange or off-exchange. On-exchange plans are purchased through government-created marketplaces, like the federal marketplace (Healthcare.gov), or a local state marketplace (however, in Utah, individuals shop for coverage only through Healthcare.gov; businesses may shop through Avenue H).
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Off-Exchange Plans
In contrast, off-exchange plans can be purchased in a lot of different ways. These are plans that are available outside of the public exchange, otherwise known as the open market.
So how do I know what to choose?
A key difference between these two options is that, if you’re eligible for and want to use government subsidy to offset your premium costs, you must apply through a federal marketplace (therefore choosing an on-exchange plan). Secondly, not all health insurance companies offer on-exchange plans in the federal or state marketplaces, so you’ll have greater plan choice when you shop through the open market.
Fortunately, none of these plans differ in terms of coverage or the quality of care provided. The Affordable Care Act mandates that all insurance plans cover the same set of essential health benefits. The only variation in coverage depends on the plan category you choose. Plan categories (referred to as “metal categories” because there are bronze, silver, gold, and platinum levels) are based on how you and your provider split the costs.