On-exchange and off-exchange health insurance plans are known as public and private plans, respectively. They are also known as marketplace and non-marketplace plans. On-exchange plans are obtainable through a public health insurance exchange, such as healthcare.gov or other state exchange website. Off-exchange plans are obtainable through various methods, such as through an insurance broker or directly from a health insurance company’s website.
Both types of plans must include the 10 essential health benefits (EHBs), as required by the Affordable Care Act (ACA). Additionally, both types of plans must be categorized as either bronze, silver, gold, platinum, or catastrophic.
On-exchange and off-exchange plans may differ in four major ways: name and design, cost, provider network, and participating carriers.
Name and Benefits
An on-exchange silver plan may differ in name and benefits from an off-exchange silver plan being offered by the same health insurance company. At a minimum, both silver plans will include the 10 EHBs, as required by the ACA. However, one may offer more benefits than the other.
If a company offers the same exact on-exchange and off-exchange plan, both plans must have the same monthly cost. However, if the plans differ, then the plans will likely have different costs.
Provider networks may also differ between an on-exchange and off-exchange plan. Using the previous example, the on-exchange silver plan may be an HMO plan, whereas the off-exchange silver plan might be a PPO plan.
Carrier options also vary. Some companies do not offer plans on the public marketplace, whereas others only sell through the public marketplace. Additionally, some companies may offer both on-exchange and off-exchange plans.