On-exchange and off-exchange health plans
Navigating health coverage can feel overwhelming, especially when faced with unfamiliar terms like "on-exchange" and "off-exchange" health plans. This article simplifies these two concepts and empowers you to make informed choices about your health coverage.
What are on-exchange health plans?
On-exchange health plans, also known as Marketplace plans, are those purchased through the Health Insurance Marketplace®, sometimes referred to as the Health Insurance Exchange.
Here are some key features of on-exchange plans:
- Standardized coverage: All on-exchange plans from all health plan providers must meet Affordable Care Act (ACA) requirements, ensuring a baseline level of coverage that includes preventive services, emergency care and more.
- Subsidies and financial assistance: On-exchange plans offer financial help to those who qualify, in the form of premium tax credits and cost-sharing reductions. These subsidies can significantly lower your monthly premiums and out-of-pocket costs.
What are off-exchange health plans?
Off-exchange health plans, sometimes called off-Marketplace plans, are purchased directly from health insurance companies or through licensed brokers. While these plans also comply with ACA standards of care, they offer different benefits:
- Flexibility and variety: Off-exchange plans may provide more options in terms of coverage, networks and benefits. This flexibility in off-exchange health plans can make them a better choice for individuals with specific health needs or preferences.
- No subsidies: Off-exchange plans are not eligible for premium tax credits or cost-sharing reductions. Higher earners who do not qualify for subsidies might prefer the added benefits an off-exchange plan offers.
- No Marketplace fees: MyPriority® Off-Marketplace plans give you the same great coverage as Marketplace plans, just without the extra fees.
Who should consider on-exchange plans?
On-exchange plans are ideal for individuals and families who:
- Need financial assistance: If you qualify for subsidies based on your income, on-exchange plans can make health coverage more affordable.
- Prefer standardized coverage: Those who don’t need specific coverage or network options should consider on-exchange plans.
Who should consider off-exchange plans?
Off-exchange plans might be a better fit for:
- High earners: If your income disqualifies you from receiving subsidies, off-exchange plans can offer comparable coverage without the subsidy factor.
- Individuals with specific health needs: Those seeking particular coverage options or wanting more flexibility in their health plan might prefer off-exchange plans.
- For those looking to avoid Marketplace fees: Some carriers, such as Priority Health, offer off-exchange plans that provide the same coverage as Marketplace plans, but without the added fees.
Making the right choice
Choosing between on-exchange and off-exchange health plans depends on your circumstances, financial situation and health needs. By exploring your options, you can find the plan that best suits you or your family.
Here are some steps to help you decide:
- See if you qualify for financial assistance: Get a free quote for a MyPriority plan, and we'll automatically check your eligibility for savings. Just check the box to find out if you may qualify for subsidies. You can also verify eligibility directly through the official Health Insurance Marketplace.
- If you qualify for financial assistance, Priority Health will show you eligible Marketplace plans. If you don't qualify, you'll still see all available plans, including exclusive off-exchange options.
- Compare coverage options: Look at the benefits, networks and costs associated with both on-exchange and off-exchange plans. To view MyPriority Off-Marketplace plans specifically, make sure you don’t check the box for subsidy eligibility.
- Consider your health needs: Evaluate whether you need specific treatments or services that might be better covered by off-exchange plans.
Need help choosing a plan?
With MyPriority, you have access to a wide variety of plans tailored to fit your needs and budget, including both on-exchange and off-exchange options. Whether you're focused on affordability, flexibility or specific coverage features, we’re here to help you make a confident choice.
Get a personalized quote or connect with one of our enrollment specialists for expert guidance every step of the way.