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. Our site offers all plans both on the healthcare.gov and plans outside the marketplace.
- With the help of an insurance agent or broker. Agents generally 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 by using 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 subsidizes 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 from an outside broker or agent. The benefit to choosing an agent outside the marketplace (like us) is that they can present other non-marketplace plan options too.
2023 Individual and Family Health Plan Guide
This guide will help compare differences between ACA compliant plans and Non-ACA plans. Non-ACA plans can save you a great deal of money and offer greater access to providers. Having said that, Non-ACA plans aren’t for everyone. If you have significant health issues and very specific needs you may need to stay in an ACA plan. Keep reading for more information.
|ACA Plan||Non-ACA Plan|
|Nationwide PPO Network||No||Yes|
|Cost||$$$$ – Expensive*||$$ – Reasonable|
|Pre-Existing Conditions||Covered||Not covered|
|Maternity, Mental Health & Preventive Care||Covered||Not Covered|
|Health Questions Required||No||Yes, 5|
|Enrollment Period||November 1st – December 15th||Year Round|
Cost* – Those whose incomes are within the sweet spot can obtain sizable subsidies making their ACA plan little to no money.
What is a Non-ACA Plan?
Non-ACA Plan is a very generalized term that people use to describe anything that is not compliant with the ACA. The problem is that a lot of plans that aren’t actual insurance get lumped in like faith-based cost-sharing plans which are not insurance. There are also a lot of new plans from carriers that no one has ever heard of pushing plans that sound like the greatest thing since sliced bread. None of these have passed our sniff test and as a result, the only non-ACA plan that we recommend is Short Term Medical Insurance (STM). Due to recent changes in the law, these plans are now able to be purchased for 12-36 months at a time.
Short Term Medical Insurance – STM
Due to recent changes in the law, these plans are now able to be purchased for 36 months at a time in many states.
STM plans are low-cost alternatives to the expensive ACA options. They are 100% real health insurance with large PPO networks. There are many benefit levels available to suit all budgets. While these plans do not cover pre-existing conditions and typically offer very little in the way of prescription coverage, they provide maximum premium savings.
What About Prescriptions?This depends on you and your present health condition. We encourage you to visit iHealthAgents GoodRx Prescription Tool and review your own prescriptions to see if you can save any money. While STM plans typically don’t cover prescriptions (some actually do), for most healthy individuals this isn’t a concern. I personally take an expensive name brand prescription that costs me $300 a month even with GoodRx, however, that said, I’m saving $1,100 a month by choosing STM over an ACA plan so for me it still makes perfect sense.
What About Healthcare Cost Sharing Ministries?
A health care sharing ministry is an organization that facilitates sharing of health care costs among individual and families who have common ethical or religious beliefs. A health care sharing ministry is not actual insurance, is not regulated by the Department of Insurance, does not use actuaries, does not accept the risk or make guarantees, and does not purchase reinsurance policies on behalf of its members.
While members of these plans are exempt from paying the tax penalty for not having health insurance, there is still a significant risk to these plans. Because these plans are not actual insurance and because of the significant risk we do not endorse these plans.
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. That being said, if you qualify for cost assistance your best choice will almost always be a subsidized marketplace plan.
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