Health Insurance Basics

If you’re married, but don’t have kids

If you’re married but don’t have kids, you don’t need to buy health insurance as a family. You can buy individual plans from separate companies, if that makes sense for you and your spouse. You can also purchase a family plan from the marketplace.

One of you can also be a dependent on the other’s employer-provided health insurance plan, if that’s available.

Which type of health insurance to buy

Generally, there are two types of health insurance: public health insurance (like Medicaid, Medicare, and CHIP) and private health insurance. Most people have some form of private health insurance, whether they purchase it through a marketplace or get it from an employer. State exchanges and the federal exchange can offer consumers both public health insurance and private health insurance.

On-exchange private health insurance

On-exchange private health insurance policies are plans that are sold on government-run exchanges, like a state exchange or, the federal exchange. On-exchange plans must cover the 10 essential benefits, plus any additional services that are mandated by your state government.

Additionally, any insurer that wants to participate in a government-run exchange must offer a plan at every metal tier (which we’ll discuss in more detail later). On-exchange private plans are the only plans for which premium tax credits and cost-sharing reductions (i.e., government subsidies for qualifying applicants) are available.

Off-exchange private health insurance

Off-exchange private health insurance policies are plans that are sold either directly by the health insurance company, through a third-party broker, or a privately-run health insurance marketplace. Off-exchange plans must cover the 10 essential benefits and follow other rules dictated by the Affordable Care Act — meaning you don’t have to worry about any loopholes or “gotchas” with off-exchange plans.

The caveat with off-exchange plans is that you typically can’t apply any subsidies (e.g., the premium tax credit or cost-sharing reductions) to these plans. (If you qualify for a subsidy, you might be redirected to your state exchange or Providing an off-exchange plan may allow an insurer more flexibility. For example, because they don’t have to offer a plan at every metal tier, insurers can offer just one type of health insurance plan.

Ultimately, if you’re shopping for private health insurance, and you’re ineligible for a premium tax credit, looking at off-exchange plans gives you more options at potentially lower price points.

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