Is an Off-Exchange Plan Different than an On-Exchange Plan?

It is possible for the same plan offered by the same carrier to have some differences.

Plans participating on an exchange may have additional regulations regarding how they are configured that may result in some differences between the on-exchange and off-exchange versions. For example, an exchange could require plans to provide pediatric vision benefits directly through the plan as opposed to a stand-alone policy working in conjunction with the main medical plan. However, both on-exchange and off-exchange plans in the individual and small group markets must provide all the mandatory Essential Health Benefits. Moreover both on-exchange and off-exchange plans in the individual and small group markets may only vary premium rates based on four factors: family size (individual or family), geographic rating area, age (up to a 3:1 ratio for adults) and tobacco use (up to a 1.5:1 ratio).

For people with lower incomes who qualify for decreased cost-sharing, there are special Cost-Sharing Reduction (CSR) versions of Silver Plans only available on an exchange. Cost sharing reductions as well as premium subsidies can only be obtained by eligible low-income individuals enrolling on an insurance exchange.