It’s the ‘Wild West’ for Individual Plans Sold Off the ACA Exchanges

The mix of individual health plans sold outside of the ACA by brokers in 2016 is very different than the coverage sold through the exchanges, according to a study by the Robert Wood Johnson Foundation and discussed on the Health Affairs blog. Plans sold outside the exchange make up about a quarter of the individual market offerings.


More than half of the off-exchange plans offer out-of-network benefits. On the exchanges, only 36% of the plans do. Silver plans on the exchanges pay 70% of covered expenses. In the off-exchange market, a third of the plans are silver.


“While the federal and state exchanges, along with creators of decision support tools, have done much to present comprehensive information to consumers about on-exchange plans, similar information has thus far been lacking for off-exchange and small group plans,” the study notes.


Or, as Katherine Hempstead, who directs the health insurance research work for the foundation, tells Kaiser Health News: “Right now the off-exchange market is kind of the Wild West in terms of how consumers know what’s available.”


Source: Health Affairs