Are the Exchanges the only way to purchase insurance?

We have all heard the news about the sluggish exchange, how many commercial policies have been
canceled, or the still pending lawsuits challenging the Affordable Care Act.  But few are aware you still have the choice to purchase your health coverage plans outside the marketplace.

According to Wendell Potter, an insurance industry watchdog, individuals shopping for coverage can still choose to skip the government-run marketplaces and buy their health coverage directly through the companies, insurance brokers or agents.  Individuals can even visit shopping sites such as eHealthInsurance.com or GoHealth.com.

A couple of things people should know about purchasing health insurance outside the marketplace.  While you should be able to find a plan your providers are participating in, the cost may be higher.  Purchasing outside the marketplace will not qualify you for any tax credits available when you purchase through the exchange.  These tax credits, based on the adjusted modified gross income for that year, could make the exchange options very attractive.  Keep in mind your adjusted modified gross income will not be known until the year ends, and you may trade the luxury of seeing your chosen provider from an in-network to an out-of-network provider or even having to locate a new provider altogether.  Deductibles, co-pays and plan differences will confuse most American citizens.

From what we understand at this time, premiums are like to be similar whether you purchase your coverage inside or outside the government marketplace.  All plans are required to provide the same "essential benefits".  Soon I suspect the marketing machine of the many payers will start up and help to muddy the waters, confusing the average consumer that much more.

As for how providers will be paid, it still remains to be seen.  We are noticing very few exchange programs that will commit whether providers will be treated as participating or not.  Many of the participating agreements from the payers are beginning to send out addendum's lowering the rates paid to providers.  While we do not have all the answers, we continue to monitor this very confusing and ever-changing topic.