Off-Marketplace Health Insurance: Your Guide to Options & Where to Buy

Overview

Not everyone buys their health insurance through the federal or state Marketplace. In fact, millions of Americans enroll in off-marketplace health insurance plans sold directly by insurers, brokers, or private websites. These options can offer more flexibility, broader networks, or supplemental coverage that fills gaps Marketplace plans don’t address. But they can also vary in rules, protections, and costs, so it’s important to know what you’re getting before you buy.

This guide breaks down how off-market health insurance works, what types of plans are available, where to shop, and how to compare options based on your needs and budget. 

Whether you’re self-employed, temporarily uninsured, or just exploring alternatives, here’s what to know.

What Is Off-Marketplace Health Insurance?

Off-marketplace health insurance refers to any major medical or supplemental health plan purchased outside the federal Health Insurance Marketplace (HealthCare.gov) or state exchanges.

These plans fall into two broad categories:

• ACA-compliant plans (same rules as Marketplace plans, sold directly)
  • Essential health benefits include outpatient care, emergency services, hospitalization, maternity and newborn care, mental health and substance use treatment, prescription drugs, rehab and habilitative services, lab work, preventive and chronic disease care, and pediatric services (including dental and vision for kids).
• Non-ACA individual health insurance options (varied rules, may not cover all essential health benefits)

Why People Consider Off-Marketplace Plans

People look at non-marketplace health insurance when they:

• Don’t qualify for subsidies (tax credits to help lower monthly premiums)
• Want a specific insurer not sold on their state’s exchange
• Prefer different network options
• Need short-term or gap coverage

ACA-compliant off-exchange plans must follow federal rules on essential health benefits, guaranteed issue, and pre-existing conditions. Non-ACA plans do not have these guarantees.

Marketplace vs. Off-Marketplace Health Insurance

The core difference between Marketplace and off-market plans is access to financial help. Consumers often wonder how off-exchange options compare to Marketplace coverage. For a deeper breakdown of how these two categories differ, see our guide on the differences between marketplace and non-marketplace health plans. You’ll learn how subsidies, benefits, and protections vary depending on where you shop and which type of policy you choose.

Important: If you are eligible for financial assistance, Marketplace enrollment is usually the most cost-effective choice.

Types of Off-Marketplace Health Insurance Plans

Healthcare consumers often don’t realize “off-market” can mean several very different types of coverage.

1. ACA-Compliant Individual & Family Plans (Direct Enrollment)

You can buy ACA-compliant plans directly from an insurance company or through a licensed insurance agent.
These plans include:

• Essential health benefits
• Preventive care
• Mental health services
• No medical underwriting

However:
You cannot receive subsidies unless you enroll through the Marketplace, according to KFF.

When ACA Direct Plans Might Make Sense

• You prefer a certain insurer not listed on your state exchange
• You don’t qualify for subsidies due to income
• You want more plan options beyond Marketplace offerings

2. Short-Term Medical Insurance

Short-term medical (STM) plans last for a limited period, often 30 to 364 days, depending on state rules. Some may be renewed for up to 3 years in certain states.

They are not ACA-compliant and may:

• Exclude pre-existing conditions
• Cap annual benefits
• Exclude maternity and mental health services

They can work for:

• Temporary coverage gaps
• Switching jobs
• Early retirees waiting for Medicare

3. Fixed Indemnity & Supplemental Plans

These plans pay a set cash amount for specific services (e.g., $200 per hospital day). They are not major medical insurance.

Useful for:

• High out-of-pocket costs on existing coverage
• People who want additional financial protection

Not recommended as a primary insurance option.

4. Health Care Sharing Ministries (HCSMs)

These are not insurance but cost-sharing arrangements run by religious-affiliated organizations.

They may:

• Require a statement of faith
• Deny coverage for certain conditions
• Have caps or waiting periods

Use with caution and only when you understand limitations.

Where Can You Buy Off-Marketplace Health Insurance?

Directly From Insurance Companies

You can shop on major insurers’ websites. This works best if:

• You know the carrier you want
• You want to compare off-exchange plans to Marketplace versions
• You don’t need subsidies
  

Pros

• More plan choices
• Direct customer support
• Clear access to provider directories

Cons

• No subsidy eligibility
• Harder to compare all carriers in one place

Licensed Insurance Agents

These agents can help compare multiple carriers, including off-exchange plans.

They can:

• Explain the differences between ACA and non-ACA options
• Help you evaluate networks and exclusions
• Assist with enrollment

Cost: Brokers are typically free to use.

Local Nonprofits or Navigators

Some organizations support consumers with insurance enrollment, though most focus on Marketplace/ACA plans.

May be useful if:

• English is a second language
• You need help with paperwork
• You want unbiased assistance

How to Compare Off-Marketplace Plans

Choosing off-exchange coverage can feel overwhelming. Here’s a step-by-step way to narrow your choices:

1. Identify whether you qualify for subsidies (premium tax credits, to help lower monthly premium costs)

Check your income against federal poverty level guidelines. If you qualify, ACA Marketplace plans may be significantly cheaper.

Be sure to estimate your eligibility using our ACA subsidy calculator, regardless of income.

If you don’t qualify for subsidies, it may be worth exploring ACA Marketplace alternatives such as short-term medical coverage. 

2. Review essential benefits

ACA plans include them; non-ACA plans vary widely.

3. Check provider networks

Make sure your doctors are in-network to avoid higher bills.

4. Review exclusions & caps

Non-ACA plans may limit mental health, prescriptions, maternity, or pre-existing conditions.

5. Compare total yearly costs

Look at:

• Premium
• Deductible
• Copays
• Out-of-pocket maximum

6. Consider your health needs

Examples:

• Someone with a chronic condition typically needs ACA-compliant coverage.
• A healthy person needing short-term coverage during a job transition may consider short-term insurance (with caution).

Bottom Line 

Off-marketplace health insurance can give you more flexibility and more ways to shop for coverage, but it also requires careful comparison.

• If you qualify for subsidies, Marketplace plans usually offer the best value. 
• If not, off-market options such as ACA direct enrollment, short-term plans, or supplemental insurance may meet your needs, depending on your health, budget, and risk tolerance.
• Always review plan documents closely, understand what is and isn’t covered, and consider speaking with a licensed broker to avoid surprises.

The right choice comes down to balancing affordability with protections and benefits you can count on.