Off-exchange health insurance plans are policies you buy through an insurance broker, through an agent or directly from an insurance company's website, rather than on a state or federal exchange. Off-exchange plans, which don't include Medicare, Medicaid or employer insurance, are still bound by ACA rules, meaning they must provide minimum coverage and the 10 essential health benefits. You can buy off-exchange plans at any time of year, but you'll lose your chance for cost-saving programs with off-exchange plans.