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Applying for an Off-Exchange Plan - do you have to medically qualify?
Old 11-25-2019, 09:29 PM   #1
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Applying for an Off-Exchange Plan - do you have to medically qualify?

If you are signing up for an off-exchange plan to start January 1, are you subject to medical review? I'm having trouble getting a straight answer on this.
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Old 11-26-2019, 12:36 AM   #2
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You are not.
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Old 11-26-2019, 05:15 AM   #3
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If you don’t qualify for ACA subsidies it is usually more convenient to bypass the exchange and buy directly from the insurance company you have selected. The rules are exactly the same. No medical underwriting. Keep in mind the Dec 15 deadline.
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Old 11-26-2019, 06:06 AM   #4
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Quote:
Originally Posted by Potstickers View Post
If you are signing up for an off-exchange plan to start January 1, are you subject to medical review? I'm having trouble getting a straight answer on this.
There are three types of off-exchange plans. The ACA-compliant ones with Bronze, Silver, Gold or Platinum in the name or description do not have medical underwriting.

Short-term Medical (STM) plans are purchased off-exchange. They have medical underwriting, exclude pre-existing conditions, and have other coverage limitations.

Health Care Sharing Ministry (HCSM) plans usually have a waiting period before pre-existing conditions are covered. They are not regulated.
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Old 11-26-2019, 08:29 AM   #5
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Old 11-26-2019, 11:19 AM   #6
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as others have said - you don't have any medical review when buying direct.

My wife and I are ending our COBRA coverage early and picking up a plan direct from the insurance companies. We decided to use an insurance broker for the process. They were familiar with all of the plans offered in our area, knew which hospitals/care networks took which types of insurance and guided us to our plan. Also, they suggested (rightly) that we pick up our vision and dental directly (not via the health care insurance) as the vision/dental offered by the health care insurance provider would have made our eye/dentist people out of network.

The insurance broker gets a small fee from the insurance company - not from you. They cost you nothing. One of the nice things was they filled out all of the paperwork - tracked it - and when the insurance company got something wrong (they messed up our primary care physician), the broker went about contacting them and getting it corrected for us.
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Old 11-26-2019, 01:01 PM   #7
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I bought off-exchange for the first couple of years of ACA. I was able to get features I wanted (like PPO and HSA) that were not available on Healthcare.gov. Other than having to buy direct from the insurer, all the ACA rules were the same, and everything I saw was ACA compliant.
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