March 15, 2021 Helpful:  0 Unhelpful:  0

Private plans are available outside the Affordable Care Act (ACA) marketplace. You can purchase them directly from an insurance company, from a broker or agent, or from a private marketplace (not run by the government). This is known as buying "off-exchange" or "off-marketplace".

Major Medical Plans

✅ All major medical plans, on-marketplace or off-marketplace, are ACA-compliant. They must include the 10 essential health benefits, and people with pre-existing conditions can't be denied coverage or charged more. 

✅ Major medical plans can only be purchased during an open enrollment period. It usually runs from November 1 to December 15. Like ACA, you can change your plan outside open enrollment if you have a qualifying life event (move outside your coverage area, get married, have a child, lose a job and more). 

✅ Off-marketplace plans don't qualify for premium tax credits or cost-sharing subsidies

✅ If you don't qualify for ACA subsidies or tax credits, it's worth looking at off-marketplace plans. You might find more choices because many insurers don't put all their plans on the ACA marketplace. 

✅ Starting in 2020, if you have an off-marketplace ACA-compliant plan and become eligible for subsidies (you have a substantial change in annual income), you can apply for an on-marketplace ACA plan of the same metal. This special enrollment period is optional for state-run exchanges, so be sure to check with your state.

Short-Term Plans

✅ You can purchase short-term plans any time during the year. These plans are for temporary insurance gaps. They are not ACA-compliant, so most don't cover pre-existing conditions (they can have many exclusions and restrictions). 

✅ As of 2021, 10 states don't allow the sale of short-term plans. Some states restrict plans to 3 or 6 months, while other states permit renewable 12-month plans up to 36 months. Find out if your state permits short-term health insurance (healthinsurance.org).

Updated:  April 13, 2021


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