While shopping for health insurance coverage, you may have come across two types of individual and family plans described as on-exchange or off-exchange plans. Both options are designed to support your overall well-being, provide essential health benefits and meet Affordable Care Act (ACA) requirements.

Comparing key differences, including options for financial assistance and enrollment, can help you select the best plan for your needs.

What is an on-exchange health plan?

On-exchange health plans are purchased through the Health Insurance Marketplace. These plans offer financial assistance through income-based subsidies, which can lower the amount you pay for your health insurance each month and decrease your out-of-pocket costs.

On-exchange health plans may be a good option for you if:

• You qualify for financial assistance through the Health Insurance Marketplace
• You’re enrolling during open enrollment or after a qualifying life event
• You’re looking to lower your monthly premiums or out-of-pocket costs

See if you qualify for financial assistance.

What is an off-exchange health plan?

Off-exchange health plans are purchased through an agent outside of the Marketplace or directly from Sanford Health Plan.

Off-exchange health plans may be a good option for you if:

• You’re confident you do not qualify for financial assistance
• You prefer to enroll directly through Sanford Health Plan
• You want plan options that are not available on the Health Insurance Marketplace
• Your employer offers reimbursement through individual coverage health reimbursement arrangements (ICHRA) or qualified small employer health reimbursement arrangements (QSEHRA)

What is included in both plans?

Whether you choose an on‑exchange or off‑exchange plan, Sanford Health Plan individual and family coverage always includes:

• Essential health benefits like preventive care, prescription drugs, maternity care and mental health services
• Coverage regardless of preexisting conditions
• Predictable cost‑sharing through standardized plan levels
• Your first 5 primary care visits free*
• Your first 5 mental health visits free*
• $0 virtual care 24/7 **
• $0 wellness visits and preventive screenings
• $0 diabetes management programs, apps and supplies

Need help with your coverage? We’re here for you.

Contact a Sanford Health Plan sales agent at no cost or obligation at (888) 535-4831 (TTY: 711) or learn more about our individual and family plans.

*Available on certain plans only. Primary care visits exclude specialty care; Mental health visits include in-person or virtual out-patient visits, see plan for full details and restrictions.

**$0 virtual care 24/7 for acute and non-emergent care available on certain plans only. Certain restrictions may apply.