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Are off-exchange plans available via HealthSherpa?
Are off-exchange plans available via HealthSherpa?

Yes! Learn more about how ACA agents can quote and enroll off-ex here.

Ricky Phipps avatar
Written by Ricky Phipps
Updated over a week ago

With HealthSherpa, agents and brokers can shop and enroll their clients in off-exchange plans.

Those who make too much to qualify for premium tax credits on-exchange could get Silver plans that are up to 30% cheaper off-exchange!

This product is currently available for select carriers and states. As our off-exchange selection grows, we will keep this resource updated.

What are off-exchange plans?

The off-exchange plans available through HealthSherpa are ACA-compliant, and rates for plans can sometimes be cheaper outside the ACA’s exchanges.

However, these plans are not eligible for subsidies. If your client could be eligible for ACA subsidies, Medicaid or CHIP, you will want to check what they qualify for on-exchange first.

Who could benefit from off-exchange plans?

Clients who fall into these three categories are most likely to find value in off-exchange plans:

  1. Households that make too much to qualify for subsidies on-exchange

  2. Individual coverage HRA (ICHRA) folks who are offered a Cafeteria plan and want to use those dollars along with HRA to pay for premiums

  3. HRA early retiree folks who prefer non-mirrored Off-ex plans to On-ex plans

  • Key reason for this would non-mirrored plans that have removed the silver loading premium amount (i.e. plans are less expensive off-exchange)

It’s important to note that many people who would’ve made too much money to qualify for subsidies before 2021 may now be eligible due to the American Rescue Plan Act (ARP).

Off-exchange plans on HealthSherpa

In this section, we’ll cover the key points to know before writing our first off-exchange policy on HealthSherpa:

  • Off-exchange plans are currently only available for select carriers and states. Review the map below to see the number of carriers offering off-exchange medical plans on HealthSherpa for Plan Year 2024 Open Enrollment. We plan to add more options over time, so check your agent account to see new additions.

Map of United States with states highlighted where we offer Off-exchange plans

How to access off-exchange shopping and enrollment

From the agent dashboard, click the quote dropdown button in the top right corner as shown below:

If your client is eligible, make sure to add their ICHRA and cafeteria amounts when quoting. They’ll be applied to the premium prices, meaning the plan list will reflect the portion of the premium the applicant will need to pay.

After choosing an off-exchange plan, you will be directed to complete an application for off-exchange enrollment.

How to view your off-exchange clients and leads

In the ‘Clients’ and ‘Leads’ tabs, you will notice an on- and off-exchange toggle. Use this to view and track your off-exchange business.

What if I don’t see any available off-ex plans?

Off-exchange plans are an actively growing offering from HealthSherpa, and for now, agents will only see plans from select carriers in certain states.

If you toggle over to off-exchange and see no plans, that means we don’t yet have this capability with carriers in the selected state. If you are an ACA agent with a HealthSherpa account, we will send you email updates when we add more off-ex plans to states you are licensed in.

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