What kinds of health insurance are there?
There are essentially two kinds of health insurance: Off Exchange Major Medical Plans which are typically PPO plans  and On Exchange Plans which are typically HMO’s otherwise known as Managed Care Plans. Although these plans differ, they both cover an array of medical, surgical and hospital expenses. Most cover prescription drugs and are priced as a tiered schedule.  Some offer only discounts on prescription drugs.

Off Exchange plans are making a comeback.  Years ago there was no such thing as on exchange or off exchange plans,  and people had no choice but to apply for insurance and hope they qualify.  Now, the Off Exchange plans mostly are PPO’s and are typically cheaper because they do not have to have the 10 minimum essential benefits that are mandatory on, On Exchange Plans. The caveat is that there are some health questions that need to be answered in order to qualify.  So typically a good agent would not offer this kind of plan for someone who has many pre existing conditions.  Also, Off Exchange plans do not qualify for any federal subsidy. 

Most people who purchase these plans have few pre existing conditions and also more than likely earn too much to qualify for a federal subsidy.  Why would someone buy Off Exchange then?  A good agent can find their client an excellent policy that works perfectly to their needs and the savings can be 30 to 40 percent cheaper than On Exchange plans.  Ask us how we can save you money.

On Exchange plans are popular for people with Pre existing conditions as they can not be turned down for coverage regardless of what medical conditions they are being treated for.   The caveat to that is that there is an Open Enrollment period that happens annually for people to apply for coverage.  If they do not apply during this period they will not get their coverage until the following year unless they qualify for a special election period such as new pregnancy or just married and coming off parents coverage. 

With these plans the only way insurance companies were able to make the plans affordable to offer on exchange they all converted their plans to HMO’s, or EPO’s with limited networks.  Otherwise considered managed care plans.  The good news is these plans are all available for those who qualify for a federal subsidy and 85% of Americans who are on these plans will pay $0 per month and have low copay’s and low out of pocket thanks to the American Rescue Plan Act (ARPA) that was passed in March of 2021.  A good agent can answer all questions, email a breakdown of any plan and help a client get the subsidy set up all without having to navigate on the government website.  Our agency’s average application for an exchange plan is 8-12 minutes.  Contact us for a quick quote and see what subsidy you qualify for.

1 – Source : MANAGED CARE AND THE STATES