Navigating the healthcare plan landscape for clients under 65 can be challenging. We aim to simplify this for you by providing insights into the individual health insurance market.

Finding a reasonably priced healthcare plan for those not yet eligible for Medicare is achievable. Below, we’ve answered the most frequent queries about the Affordable Care Act (ACA) plans and their associated exchanges.

• • What Does On- vs. Off-Exchange Mean? ACA insurance plans can be sourced through an exchange or from the carrier. Buying through an exchange gives you an on-exchange plan, while purchasing directly from the carrier provides an off-exchange plan. Depending on the state, your clients might have their state exchange instead of a federal one. Exchanges are tools that streamline comparing and selecting health insurance plans based on price, benefits, services, and quality.

  • What Are the Differences Between On- and Off-Exchange Health Plans? Many factors might sway someone to choose an on-exchange or off-exchange under-65 health plan. On-exchange plans make comparing options more straightforward and are categorized into metal tiers: bronze, silver, gold, and platinum. In contrast, off-exchange plans are attractive due to their flexibility, broader coverage choices, potential affordability, and compatibility with specific doctors.

  • Does The Government regulate both Types of Plans? Absolutely. The ACA’s rules and standards bind both on-exchange and off-exchange plans. This includes ensuring they cover ten vital health service categories. While off-exchange policies aren’t necessarily Qualified Health Plans, many align with the requirements of one. Critical periods for enrollment and qualifications are consistent for both types of plans.

  • Can I Sell Both On- and Off-Exchange Plans? Definitely! Agents have the flexibility to offer both plan types. Some training or certification might be necessary, but giving clients the entire range of options is worth it.

  • Do I Earn the Same Commissions for Helping Clients Find a Plan On- and Off-Exchange? Commission structures might vary based on whether the plan is on- or off-exchange. Always check with individual carriers for their specific rates.

  • Are Clients Eligible for ACA Subsidies If They Purchase Off the Exchange? Subsidies are exclusive to plans bought on the exchange. It’s worth noting that some clients might be missing out on potential savings if they opt for off-exchange plans without being aware of subsidy eligibility.

  • How Can I Find Out if My Clients Qualify for a Subsidy? To determine subsidy eligibility, familiarize yourself with the IRS’s income eligibility criteria. This knowledge empowers you to provide the best recommendations for your client’s needs and budget.

  • What Is Enhanced Direct Enrollment? Enhanced Direct Enrollment (EDE) is a system that streamlines the on-exchange enrollment process, eliminating the need to visit HealthCare.gov. Platforms like HealthSherpa have integrated this system to improve the user experience and reduce enrollment times.

  • What Are the Metal Tiers? The metal tiers – bronze, silver, gold, and platinum – categorize marketplace plans by their coverage levels and associated costs.

  • What Are ‘Excepted Benefits’ Under the ACA? Excepted benefits, often sold outside the exchange, are exempt from standard ACA rules. They fall under categories like limited health benefits and specific disease coverage. For more detailed information, visit CMS.gov.

Embarking on your journey through the ACA market might seem daunting initially, but we trust these answers shed light on the subject. For any other questions or guidance, connect with an under-65 sales specialist. We look forward to supporting your endeavors in the under-65 health insurance arena!