01
Marketplace coverage is private insurance
Marketplace health plans are offered by private insurance companies. Buying with help from an agent does not necessarily mean buying outside the Marketplace. Ask whether an application is being submitted through the Marketplace and which eligibility and financial-assistance rules apply.
02
Off-Marketplace is not one product category
Some coverage sold outside the Marketplace is ACA-compliant comprehensive insurance. Other products have different protections and limits. Ask directly whether the policy is comprehensive major medical, whether it is ACA-compliant, and how pre-existing conditions are treated. Do not infer the answer from the word private.
03
Check what the policy promises
Compare covered services, exclusions, networks, prescription benefits, underwriting and payment limits. Marketplace plans cover pre-existing conditions under applicable protections. Do not assume every non-Marketplace product provides the same protection, or that an inexpensive benefit schedule pays the full cost of care.
04
Keep the documents
Request the policy, relevant benefit summary and written explanation of the product type. Compare assistance eligibility only through the appropriate official process. If the description is unclear, pause and get clarification before replacing existing coverage.
Further reading: HealthCare.gov: coverage options and plan changes
HealthCare.gov: pre-existing conditions
CMS: about the Health Insurance Marketplace