Do plans cost the same on-exchange and off-exchange?

What it means

• The rate-parity rule applies to a specific qualified health plan (QHP) identified by its plan ID — the same plan carries the same premium in every distribution channel.
• Any advance premium tax credit is available only through the Marketplace, so a subsidy-eligible household pays less net-of-subsidy for the identical plan bought on-exchange than off-exchange even though the sticker premium matches.
• Off-exchange-only plans exist because an issuer can decide which of its qualified health plans to file with the Marketplace and which to sell only through direct and agent channels.

Action steps

1. When comparing an on-exchange quote to an off-exchange quote for the same plan ID, expect the pre-subsidy premium to match to the cent.
2. For a household above the ACA subsidy cliff, request off-exchange-only quotes in addition to the on-exchange versions — that widens the network and benefit-design set the buyer can pick from.

Risks & deadlines

• The rate-parity rule does not require the same plan to be sold in both channels — an issuer may withdraw a plan from the Marketplace and continue selling it off-exchange (or the reverse).