Buying Insurance Outside of the Marketplaces

On June 25, 2014, the Supreme Court of the United States (SCOTUS) determined that the “by the state” wording in the Patient Protection and Affordable Care Act (The ACA or “Obamacare”) applied to both state and federally-run marketplaces.


This was a landmark decision because, had the SCOTUS determined the wording did not apply to the Federal marketplaces, 6.4 million people from the 37 states that opted not to create their own marketplaces would have lost their subsidies and, ultimately, their insurance coverage.

However, because the SCOTUS determined by a 6-3 margin that the subsidies do apply, those individuals and families can now rest easy, secure in the knowledge that they can continue to afford coverage.

While the SCOTUS ruling is good news to a majority of Americans, there are still those who will fall through the cracks either because they either make too much to qualify for the subsidies; or because they make too little but fall outside of the minimum wage limit to qualify for Medicaid.
These individuals might still be able to purchase plans through the federal marketplace, but without the subsidies – which means they will end up paying more for coverage.

However, these individuals also have an additional option of bypassing the marketplaces entirely, and purchasing a plan directly from providers like Anthem Blue Cross/Blue Shield and USHealth Group.

On the surface, this might not seem like a big deal, but there are some advantages to purchasing a policy directly from the provider.

Advantages to Purchasing a Policy Directly From a Provider

A Wider Choice of Plans

The marketplaces only have certain numbers and certain types of plans from certain providers. Some of those plans are from large, well-known providers and others are from smaller providers that you might never have heard of otherwise. Because providers can opt not to participate in the marketplace, you find that your choices are limited. You might even find that your preferred provider is not on the list. Even if your provider is on the list, there will only be a limited number of insurance products.

However, if you go directly through the provider, you can choose any provider that’s available in your area, and any of the product that they offer. Having a wider choice of plans means that you have more control over the type of coverage that you get as well as things like copays, deductibles, and prescription drug coverage.

The Chance for Better-Rated Plan

Because the choice of marketplace plans is limited, you pretty much have to choose whatever is available. While many of the plans are quite good, depending on what’s available in your area, you could end up choosing a provider with less than stellar reviews and ratings. When you go outside of the marketplace, you can actually read the reviews and ratings for different providers and make a more informed choice. Additionally, you can also look up other information about the provider to help you make your decision. For example, if the way a company treats its employees is as important as the services it provides, you can find that information on sites like Glass Door.
For example: you can find employee reviews of USHealth Group insurance before you even look at their plans.

Better Provider Lists

One of the complaints about the marketplace plans is that certain healthcare providers are not available. There can be several reasons for this, including the fact that certain healthcare providers have opted not to participate in subsidized plans. If you have a doctor whom you absolutely need to keep, and who does not participate in a marketplace plan, you can find him on one of the thousands of plans offered directly from the insurance providers.

Remember, insurance companies don’t necessarily provide all of their products through the marketplace, which means there could be several non-marketplace plans that will cover the healthcare providers that you need.

As you can see, the state and federal marketplaces are good for those who qualify for the subsidies. However, those who don’t, or those who do not wish to use the marketplaces, can also benefit from buying directly from the insurance providers.


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