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Coverage Outside the Marketplace

The Affordable Care Act created health insurance marketplaces that exist in each state. These marketplaces enable consumers to shop for and compare health plans, and access premium tax credits and cost-sharing reductions to make health insurance more affordable. However, coverage is also available outside of the marketplaces.

Some health plans sold outside the health insurance marketplace are required to provide the same basic set of benefits as plans sold inside the marketplace, are not allowed to exclude coverage of a pre-existing condition, and are also required to provide a minimum level of financial protection to their consumers. However, it is important to note that you may only obtain premium tax credits and cost-sharing reductions if you purchase a plan through the health insurance marketplace.

Contact your state’s Department of Insurance for a list of reputable brokers who can direct you to these plans, which are sold outside the marketplace, but are still required to provide the same protections as plans sold inside the marketplace.

There may be other coverage options available outside of the marketplace that are not required to provide the Affordable Care Act’s protections as described above. These include plans that are not traditional health insurance products, including short-term, limited duration insurance, association health plans, health care sharing ministries, and farm bureau plans. If an insurer or entity cannot provide a Summary of Benefits and Coverage that indicates the coverage is Minimum Essential Coverage, be aware that the plan may have coverage limitations, particularly for pre-existing health conditions or for basic medical care.

Proceed with caution when evaluating options outside of the health insurance marketplace, as there have been reports of fraudulent activity and deceptive practices. In order to evaluate your options outside of the marketplace, contact your state’s Department of Insurance for a list of reliable brokers who can assist you in assessing your options.