On exchange vs. off exchange health insurance plans

*This post applies to under age 65 only.


Health insurance isn't limited to Covered California. If you're ineligible for premium assistance, frustrated by the CoveredCA.com website, or just want to opt out of the Obamacare plans, you can shop off the exchange.

When does it make sense to buy off the exchange?

If you don't qualify for premium assistance (and know for sure that you won't in the upcoming year), then off exchange might be a better option for you.

If you’re earning less than 400% of the poverty line after factoring in family size and income, then you'll probably want to buy on the exchange through Covered CA. This is the only way to get financial assistance with your health insurance. 

What are the advantages of going off exchange?

  • More plan options–all health insurance plans are required to carry the essential health benefits required under the Affordable Care Act. While on the exchange you're limited to the four metal tiers Bronze, Silver, Gold, and Platinum, off exchange can give you extra options in between.

  • Premium–premiums for the same health plan are the same on and off the exchange. If there's an issue with payment, you won't need to contact Covered California. You can get it sorted out directly with the health insurance carrier.

  • Less paperwork–if you don't need premium assistance, you don't need to pull pay stubs and confirm your identity with passports and driver's licenses. The application process is quicker and simpler.