When applying for individual health coverage, you have two options: you can either apply through the health market exchange or go direct with a carrier.

While most plans are available on and off the exchange, some are only offered through the exchange. Likewise, there are some carriers who only participate in the individual market off of the exchange. However, all plans offered on and off the exchange are ACA compliant and have all the benefits of being a qualified health plan.

It’s also important to note that if you begin the year with an income that isn’t subsidy-eligible and your income drops during the year to a level that would make you eligible for a subsidy, you would only be able to start getting a subsidy at that point if you were already enrolled in an exchange plan. If you opt for an off-exchange plan during open enrollment, you won’t be able to switch to a subsidy-eligible exchange plan until the next open enrollment, regardless of any mid-year changes in your income.

 

Buying insurance on the Exchange

Buying on the exchange means going through Healthcare.gov. Going through the exchange is the only way to see if you qualify for any financial assistance paying your monthly health insurance premiums.

Some plans will only be available to purchase through the exchange. In addition, if you need to make any updates to your application (i.e. spelling of your name or change of address), you will have to contact the marketplace and make an update with them, and they will pass the information off to the carrier.

When shopping for a plan, you will see plans from different carriers available in your area. Sometimes will have to provide the exchange extra documentation (such as income verification, citizen status, etc.).

 

Buying insurance direct with a carrier

You also have the choice to apply directly for health insurance with the carrier you chose. Enrollment is fast and easy, but you won’t receive financial assistance.

In Oregon, you will have access to two carriers whose plans are not offered on the exchange. If you want to shop off-exchange, you can purchase a policy directly from a health insurance carrier, or from an agent or broker; the price will be the same either way.

Even if you know that you won’t qualify for subsidies in the exchange, you’ll want to consider exchange options as well as off-exchange plans to find the policy that best meets your needs.


Do your research and choose the best option – direct or on the exchange – for you and your family. With questions, contact us at NW Benefit Advantage today!