Insurance Blog 13 march 21

Do I Have to Buy Insurance from the ACA Marketplace?

Regardless of your current situation, you may be able to take advantage of health insurance plans outside of the Affordable Care Act (ACA) Marketplace. These types of plans are available through private insurance companies or companies that offer private health insurance coverage in addition to ACA coverage.

Once you go outside of the Marketplace, you will have more options for insurance plans, with greater flexibility. However, the downside is that you may not get quality health insurance that meets your medical needs. For this reason, you need to go through a health insurance broker or agent when looking for insurance. They can ensure that you get quality health insurance at affordable rates.

What is Private Health Insurance?

Private health insurance refers to any health insurance coverage offered by a private provider instead of a state or federal government. Insurance brokers and health insurance companies both fall into this category. Where can you find private health insurance plans?

  • Licensed health insurance broker or agent
  • Group health insurance through your employer
  • ACA marketplace plans designed for special situations

Some private health insurance plans offer benefits that meet the minimum essential coverage requirements of the Affordable Care Act. Other plans might offer different benefits, such as short-term or catastrophic coverage. These plans may not count as private health insurance options, such as short-term plans and catastrophic coverage, may offer different benefits but may not count as a qualified health plan under the Affordable Care Act.

Private Health Insurance Through ACA Health Insurance Companies

Just because a health insurance company offers private health insurance does not necessarily mean that it is a private company. Some providers in the Marketplace offer private coverage that counts as qualifying health coverage. Several features distinguish private health insurance from ACA health insurance, including

  • These plans meet all healthcare law requirements, including covering pre-existing conditions, providing free preventive care, and not capping annual benefits. 
  • The Marketplace does not list or offer these plans. The only way you can enroll in a health plan through the Marketplace outside Open Enrollment is to qualify for a Special Enrollment Period.
  • You can find private plans through insurance companies, agents, brokers, and online health insurance sellers. If you buy a plan outside the Marketplace any time, during Open Enrollment or not, you can’t get premium tax credits or other savings based on your income.
  • Insurance companies can tell you if a particular plan counts as minimum essential coverage. Each plan’s Summary of Benefits and Coverage also includes this information.

How Do I Buy Private Health Plans Outside the Marketplace?

If you do not qualify for health insurance under a Special Enrollment Period, you will need to find private insurance that you can enroll in throughout the year. How do you buy private health insurance?

Directly from an Insurance Company

You can contact any health insurance company and see plans available in your area. Many have websites that let you compare all plans available from that company. 

An Insurance Agent or Broker

Agents generally work for a single health insurance company. Brokers generally sell plans from several companies. They can help you compare plans based on features and price and complete your enrollment. You don’t pay more by using an agent or broker. They’re generally paid by the insurance company whose plans they sell.

From an Online Health Insurance Provider

These online services offer health plans from several insurance companies. They let you compare prices and features and then enroll with the insurance company.

What Are the Main Types of Private Health Insurance?

Private insurance offers the same plans as ACA insurance. Some of the main health insurance plans include

Health Maintenance Organization (HMO)

A health maintenance organization (HMO) is a company that’s organizational structure allows them to provide insurance coverage for their subscribers through a specific network of healthcare providers. Typical features of an HMO include paying for insurance coverage for a monthly or annual fee. Premiums tend to be lower for HMOs because health providers have patients directed at them. Still, the disadvantage is that subscribers are limited to accessing a network of doctors and other healthcare providers who are contracted with the HMO.

Preferred Provider Organization (PPO)

A preferred provider organization (PPO) is a type of insurance plan in which medical professionals and facilities provide services to clients at reduced rates. Healthcare providers that are part of this network are called preferred providers or in-network providers. Subscribers of a PPO plan can see healthcare providers outside of this network of providers (out-of-network providers), but the rates for seeing these providers are more expensive.

Exclusive Provider Organization (EPO)

An exclusive provider organization (EPO) is a hybrid of the HMO and a PPO plan. With an EPO, you can only receive services from providers within a certain network. However, exceptions can be made for emergency care. Another characteristic of an EPO plan is that you may be required to choose a primary care physician (PCP), a general practitioner who will provide preventative care and treat you for minor illnesses.

Contact Insurance Enterprise for Premier Health Insurance

 If you have questions about group or individual health insurance and need health insurance quotes, contact Insurance Enterprise at 888-350-6605. Speak to a licensed agent and find out more about how you can get an affordable health insurance plan.