THURSDAY, DECEMBER 4, 2014
Now that Obamacare open enrollment is here, I’m getting lots of questions as to whether someone should apply for a plan ON THE EXCHANGE as opposed to one that is OFF THE EXCHANGE. You may also hear On The Marketplace or Off Marketplace. (exchange and marketplace mean the same thing.). 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 (in the form of premium assistance or out-of-pocket reductions). There is no such assistance available for Off-Exchange plans.
The choice of On Exchange vs. Off Exchange depends on timing as well as income considerations.So, like most things in life, it all comes down to time and money ;) Here’s what we're telling our customers. It’ll work for you too.
When you should consider an Obamacare plan On Exchange
When you are eligible for and would like to receive financial assistance for paying premiums and/or reducing out of pocket amounts
The amount of financial assistance is determined by family size and income as a percentage of the Federal Poverty Level (FPL). If you’re at 138%-400% of the FPL for your income level and family size, you’ll get some sort of premium assistance. If you’re over 400%, you get nothing.
You can get an estimate of the amount of help you could receive by visiting the Henry J. Kaiser Family Foundation Subsidy Estimator at http://kff.org/interactive/subsidy-calculator/.
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 Annual Open Enrollment
The Annual Open Enrollment Period for 2015 is November 15, 2014- February 15, 2015.
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
When you should consider an Obamacare plan Off Exchange
When you don’t qualify for any sort of financial assistance
To get a health insurance plan On Exchange in the state of Ohio, you must use healthcare.gov to enroll. There might be one or two companies that have direct, easy-access portals that integrate with healthcare.gov, but I think those are few and far between. And although healthcare.gov has improved significantly, it's still not the easiest process. So, if you don't HAVE to use healthcare.gov and instead can use an enrollment process directly through the insurance company, that's often more desirable and easier.
When you’re outside of the Annual Open Enrollment Period
If you don’t enroll by February 15, 2015 and don’t have access to any other coverage (employer-based, Medicaid, etc.), AND don't have a special enrollment situation, you will have to purchase a plan Off-Exchange. And the only plans available in these situations are Short Term plans (up to 6 months of coverage). These plans are NOT subject to Obamacare, so you do have to pass limited medical underwriting to be approved.
Open enrollment for 2015 lasts through February 15, 2015. Don't go it alone- Contact Alan Galvez Insurance at 937-592-4871 to talk with our Obamacare specialists.
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