THURSDAY, NOVEMBER 19, 2015
We get LOTS of questions about whether someone should apply for Ohio health insurance On-Exchange OR Off-Exchange (and for those that need further clarification- the Exchange is also referred to as the Health Insurance Marketplace, commonly called the Marketplace).
It seems what confuses most people is simply the difference between the two.
Here's the difference between On-Exchange and Off-Exchange
On-Exchange simply refers to plans that are eligible for financial assistance from the government (called Premium Tax Credits or Subsidies). These plans are purchased through healthcare.gov. Off-Exchange are plans that are not eligible for a premium tax credit. They are purchased from the insurance company, whether directly or via agents like us (and we've specialized in Ohio health insurance for over 25 years).
Keep in mind that no matter which route you go, you're still buying HEALTH INSURANCE. And it does what it's always been designed to do- help pay your covered medical expenses.
How to choose Ohio health insurance: On-Exchange versus Off-Exchange
- You would choose On-Exchange when you are eligible for and would like to receive the premium tax credit and/or reduce out of pocket amounts
We have a process at our office that helps determine right away if you're eligible for the credit or not. The Marketplace determines the amount of financial assistance by family size and household income as a percentage of the Federal Poverty Level (FPL). We have charts that give a range of incomes and household sizes. If you fall within the range for your income and household size, chances are good you qualify.
- You would choose On-Exchange if you’re age 30 or younger and need health insurance to meet the individual requirement, but have a financial hardship
Catastrophic plans are available for people age 30 and younger with financial hardship situations as defined by the Federal Government. These are very high deductible plans designed for catastrophic situations. They meet the individual mandate requirements. If you’ll remember the law requires everyone to have health insurance- called the “individual mandate.”
- When it’s Open Enrollment time
Open enrollment for 2016 is November 1, 2015- January 31, 2016. If you miss this deadline, you have to wait until the next open enrollment.
There is an exception- coverage in the exchange is available at other times if you have a qualifying event such as:
• Moving to a new state
• Certain changes in your income
• Changes in family (such as marriage, divorce, birth or adoption of child)
• Loss of job-based coverage
• Existing insurance is being discontinued
This is called a Special enrollment.
- You would choose Off-Exchange when you don’t qualify for the premium tax credit
Enrolling via healthcare.gov is a very involved, lengthy process. It requires a lot of information, including financial information about all the members of your household. If you don't qualify for any help with your premium, then there is no reason to go this route. As an example, I can enroll someone in an Off-Exchange plan in about 10 minutes. Enrolling via healthcare.gov can easily take 30-60 minutes depending on the size of your household.
- You would choose Off-Exchange if you simply don't want the government involved with your health insurance (at least more than they are now). As mentioned before, to get the premium tax credit, you have to give up A LOT of information and some people object to that. So if you fall in that camp, Off-Exchange means you work directly with the insurance company (usually via agents like us) to enroll.
These are some common examples to help you choose whether to buy Ohio health insurance On-Exchange or Off-Exchange.
Questions? Need help with this often confusing process of choosing Ohio health insurance or more information? Call Alan Galvez Insurance at (937) 592-4871 or contact us via our website. You can also visit our Ohio health insurance resources and request a quote.
NOTICE: This blog and website are made available by the publisher for educational and informational purposes only.
It is not be used as a substitute for competent insurance, legal, or tax advice from a licensed professional
in your state. By using this blog site you understand that there is no broker client relationship between
you and the blog and website publisher.