Can I buy health insurance outside of the Marketplace that meets all ACA standards?

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Yes.  Many insurers that offer policies through the Marketplace also offer identical policies outside of the Marketplace, in the individual health insurance market.  These ACA-compliant policies also will meet all ACA standards.  They will cover essential health benefits; and they won’t turn you down, charge you more, or limit coverage based on your pre-existing condition.  In addition, ACA-compliant policies will be offered only during Open Enrollment, or at other times during the year, only to people who are eligible for a special enrollment period (SEP).

Sometimes people prefer to buy outside of the Marketplace, for example, when they are sure they won’t qualify for financial assistance. However, many other policies that are not ACA-compliant are also for sale outside of the Marketplace, and this can make comparison-shopping more complicated.

Some signs that a health policy is not ACA-compliant include:

  • The application asks questions about your health status or health history
  • The policy doesn’t cover essential benefits, such as maternity care or prescription drugs
  • The policy has annual or lifetime dollar caps on covered benefits
  • The policy is offered for sale outside of Open Enrollment to people regardless of whether they’re eligible for an SEP, for example, because they recently lost other coverage

Plans that are not ACA-compliant, including short-term health insurance, may have lower premiums because they can exclude people with pre-existing conditions and offer more limited benefits.

If you are shopping outside of the Marketplace and you want an ACA-compliant policy, be sure to specify that to the insurer or broker you’re working with.

Finally, even if you think you won’t qualify for financial assistance, it still might be worthwhile to shop for coverage on the Marketplace.  All policies offered through the Marketplace will meet ACA standards; no other non-compliant products are sold there.

While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.

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