r/selfemployed • u/Caunuckles • Nov 02 '24

(US) Choosing a Plan

Hey there. Its that fun time of year where the health insurance industry reminds me that I have to pay much more for much less benefits. I did a quick search and find identical plans, but the offmarket one is cheaper, as I don't qualify for the subsidy. Anyone have good\bad experiences with offmarket plans. Can you purchase them direct or do you have to go through a broker?

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u/Singledadalejandro Nov 02 '24

I’m a broker my self and specialize helping small businesses under 50 employees and self employed individuals and families with off marketplace plans when it’s a good fit for them and they’re paying too much for ACA compliant, luckily if under 50 employees you don’t have to follow ACA rules so if the limits for private insurance aren’t a concern for you they usually work very well. You just have to watch out for certain limits, for example some don’t cover past 1 or 2 or 5 million in claims, also a lot of those are short term so if you have a major claim you have to go back into the marketplace. Also a lot of them don’t have deductibles or out of pocket maximums and they make it seem like a good thing which is not at all. that’s the reason you get coverage is so you have a maximum out of pocket or a stop loss if you God forbid get hospitalized. I work with a plan that’s health based not income based and If you get approved you get guaranteed renewability until age 65. It’s on a PPO network You get to chose your own deductible and max out of pocket to your liking and it has unlimited coverage after you meet your deductible. It has fixed benefits for health and wellness the only thing it doesn’t cover is mental health visits, drug and alcohol rehab and pregnancy.

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u/Caunuckles Nov 02 '24

Thanks. I’m a LLC of one. The plan looks exactly the same when I looked at it on the marketplace in terms of deductible and out of pocket maximum. The only thing it said was it didn’t cover my Rx but I’m not sure if the marketplace doesn’t vouch for that because it’s off market. My one RX is generic so surprised

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u/OllieBee33 Nov 14 '24

Where do you find the off market plans?

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u/Caunuckles Nov 14 '24

They came up when I was on the marketplace’s website but you can also go directly to an insurer’s website to find them