Final answer:
When purchasing a Qualified Health Plan outside of the ACA Marketplace, consumers are not eligible for government subsidies, including advanced premium tax credits and cost-sharing reductions, which are only provided through plans obtained in the state-sponsored health insurance exchanges.
Step-by-step explanation:
If a Qualified Health Plan is purchased outside of the Marketplace, consumers will not have access to certain government subsidies which are designed to make health insurance more affordable. Under the Patient Protection and Affordable Care Act (ACA), popularly known as Obamacare, the establishment of health insurance exchanges, also known as marketplaces, allows individuals and small businesses to shop for various insurance plans with the goal of increasing competition and reducing the overall prices of policies.
However, purchasing insurance outside of these exchanges means missing out on the opportunity to qualify for income-based subsidies. These subsidies include advanced premium tax credits that lower monthly premium costs, and cost-sharing reductions that lower the amount one pays for deductibles, coinsurance, and copayments.
The ACA seeks to mitigate the problem of adverse selection—where sicker individuals are more likely to purchase health insurance—by requiring everyone to have insurance. This approach also includes provisions that prevent insurance providers from denying coverage based on preexisting conditions. Despite the options provided by the ACA, a significant number of Americans remain uninsured, often due to employment at smaller companies or in lower-paying jobs that do not include health insurance benefits.