ON-EXCHANGE HEALTH INSURANCE PLANS

These plans comply with standards set by The Affordable Care Act (ACA) and offer subsidies in the form of a premium tax credits for individuals and families with income below 400% of the federal poverty level.

On-Exchange plans are categorized into four metal tiers: Bronze, Silver, Gold and Platinum, providing consumers a general reference for the monthly premium costs compared to the out-of-pocket costs of the plan. For example, Bronze plans offer the lowest monthly premium but charge the highest deductibles, copayments and coinsurance for covered services.

The Affordable Care Act requires on-exchange plans to cover at a minimum 10 essential health benefits plus birth control and breastfeeding services. ACA compliance also mandates that insurance companies can not subject individuals to medical underwriting or exclude any coverage due to a pre-existing health condition.

In order to get financial assistance, such as premium subsidies and cost sharing deductions, for ACA On-Exchange Marketplace Plans, you must:

• Meet the household income requirements

• Not have access to affordable coverage through an employer

• Not be eligible for Medicaid or CHIP

• Not be eligible for premium-free Medicare Part A

• File a joint tax return with your spouse if you are married, and

• Not be able to be claimed by someone else as a tax dependent

OFF-EXCHANGE HEALTH INSURANCE PLANS

Private agencies and brokerages run off-exchange markets that offer health insurance to individuals and employers. Consumers in this marketplace have the option to choose between ACA compliant plans and non-compliant policies. Off-exchange coverage varies from market to market and can include:

• ACA-Compliant Qualified Health Plans

• Short-Term Health Plans

• Catastrophic Health Plans

• Wellness Services

• GAP Insurance

• Medical Indemnity Insurance

• Vision and Hearing Plans

• Dental Plans

• Group Coverage for Large Employers

All plans considered major medical plans that cover hospitalization and severe illness expenses must comply with ACA standards whether they have on-exchange or off-exchange status.

Off-exchange "expected benefits" policies such as short-term coverage, catastrophic health plans, fixed indemnity insurance, and dental or vision policies are exempt from many ACA regulations.

The cost of off-exchange plans vary widely depending on the insurer, policy details and medical network. Generally, they cost more than similar on-exchange plans since off-exchange plans never include premium subsidies (premium tax credits).