Benefitra launches health plan compare tool for sole proprietors

Benefitra has rolled out a nationwide plan comparison tool aimed at sole proprietors, pairing off-exchange coverage with state Marketplace options and checking hospital networks across 349 top hospitals. The Boston brokerage says the tool is meant to help self-employed people see tradeoffs more clearly as ACA costs keep rising.

Why it matters: - Sole proprietors do not have employer coverage to fall back on, so small differences in networks, specialty drug coverage and underwriting can change real-world costs. - ACA Marketplace premiums are rising again, making off-exchange options more relevant for some self-employed buyers who do not qualify for subsidies. - Benefitra says the new tool is designed to show the tradeoffs side by side before a person enrolls.

What happened: - Benefitra, a Boston health insurance brokerage, launched the Benefitra Nationwide Health Plan Compare for sole proprietors. - The online tool compares four nationwide health plans with state exchange options. - The platform asks a few questions, filters out plans a person does not qualify for, and then shows the remaining choices. - Benefitra says the tool is built for sole proprietors and is not intended for people who are not self-employed.

The details: - The comparison includes network information, specialty drug coverage and estimated costs. - Benefitra read each plan’s own documents and compared them benefit by benefit. - The research also checked 349 top-rated hospitals in 50 states against each plan network in October 2026. - The tool includes 21 hospitals on a national list and 80 children’s hospital listings in 35 states. - Benefitra says the hospital review helps buyers spot gaps before choosing a plan. - The four programs shown are Solo Health, Triad’s Cigna PPO plans, Core Choice and Population Science Management’s Aetna Livelihood plans. - Solo Health uses the MultiPlan PHCS network. - Triad uses the Cigna Choice Fund PPO network. - Core Choice uses the Blue Cross Blue Shield National PPO network. - PSM uses the Aetna Signature Administrators network. - The tool’s comparison chart tracks the 10 essential health benefits, ACA consumer protections, plan facts and specialty medications. - Each cell shows a status, a short label and the source document behind it. - Triad is not available in New York. - PSM is not offered in California, Connecticut, Hawaii, Maryland, Minnesota, Mississippi, New Hampshire, Oregon, Pennsylvania, Vermont, Washington or Wisconsin. - Benefitra says the four programs are not the full set of plans it reviewed. - The company excluded plans that did not fit a niche or meet its coverage standard. - For the programs shown, Benefitra recommends Triad’s Cigna PPO plans over Triad’s reference-based pricing option. - Benefitra also recommends PSM’s Aetna Livelihood plans over its lesser coverage options.

Between the lines: - The launch lands as Marketplace costs continue to climb and enhanced premium tax credits have expired. - KFF reported on October 30, 2026 that finalized benchmark silver premiums will rise an average of 13% in 2027. - KFF also found benchmark silver premiums have increased 42% on average between 2025 and 2027. - For 2027 open enrollment, the increase is 11% in HealthCare.gov states and 16% in states with their own enrollment platforms. - KFF said open enrollment for 2027 began November 1, 2026 in most states. - Peterson-KFF reported that effectuated Marketplace enrollment fell 12%, or 2.6 million people, by February 2026 to 19.2 million. - Peterson-KFF said 87% of people who signed up for a Marketplace plan in 2026 received a premium subsidy. - Benefitra’s tool is especially aimed at buyers who may be priced out of exchange coverage or want to evaluate off-exchange plans that are harder to compare. - The tool is also blunt about fit: it flags plans as a poor match for people taking specialty medications or undergoing expensive ongoing treatment.

What the tool shows: - The screening process starts with questions about self-employment, specialty medication use and willingness to complete short monthly surveys. - Some answers can remove plans immediately, including requirements tied to self-employment or monthly survey participation. - After screening, users choose a state and enter age and household type. - The results page shows remaining plans with network details, estimated starting prices, specialty drug coverage, notes, alerts and hospitals that may be out of network. - Users can assign extra value to specific hospitals with a slider, and the tool flags plans that may not include those hospitals. - The tool also calculates a Coverage Adjusted Premium by adding annual premium, the user’s hospital preference value and the cost of specialty medications a plan does not cover. - Benefitra says that figure is premium-only and does not model deductible or out-of-pocket costs. - Answers stay in the browser tab, are not saved or sent anywhere, and disappear if the page is reloaded.

The details on each program: - Solo Health launched in 2023 through Healthy Business Group, founded in 2009. - Solo Health is simplified issue, with approval based on a health questionnaire. - Solo Health’s deductible equals its out-of-pocket maximum. - Solo Health pays at most $1,000 per specialty prescription per 30-day fill after the deductible. - The tool warns members to check each doctor because PHCS operates differently. - Triad started in 2010 and says it has about 80,000 members. - Triad uses health questions and places applicants into one of seven rate tiers, so quoted premiums are estimates until a tier is assigned. - Triad covers specialty drugs at 50% coinsurance for a 30-day supply only. - Core Choice uses four household tiers and does not age-rate members. - Core Choice coverage cannot be denied for pre-existing conditions, according to carrier notes cited by the tool. - Core Choice does not cover specialty medications. - Core Choice prices are estimates until current rates are confirmed. - PSM requires a suitability tool before it shows plans or quotes. - PSM verifies answers afterward through a health information check by Milliman. - PSM’s Form 5500 filing reported 58,787 participants as of December 31, 2025. - PSM plans do not cover specialty medications.

The hospital check: - Benefitra started with U.S. News & World Report’s top hospitals for each state and nationwide. - The team then checked each hospital against each plan’s provider directory and, for some hospitals, a published price file. - Of the 349 state hospitals, Benefitra found 343 in the Blue Cross Blue Shield National PPO network. - The research found 339 of those hospitals in the Aetna Signature Administrators network. - The research found 333 of those hospitals in the Cigna Choice Fund PPO network. - The research found 236 of those hospitals in the MultiPlan PHCS network. - Hospitals that were not verified were marked out of network, likely out or not yet verified. - The page notes that “unverified” does not mean out of network. - Benefitra says hospital contracts can change, even if they are relatively stable, and buyers should confirm providers in the directory before enrolling.

How Benefitra is paid: - Benefitra says commissions are built into the premiums. - Benefitra is credited for helping a person find a plan. - For PSM, Benefitra says it acts as a recruiter rather than a broker when providing information about those plans. - For Triad, Core Choice and Solo Health, Benefitra acts as the person’s broker.

What's next: - Users can click Get a Quote / Enroll on each plan card to see required disclosures before submitting a request. - The tool also offers a personalized recommendation and lets users change inputs, such as the value placed on certain hospitals, to update the comparison. - Benefitra’s broader planning resources include freelancer health coverage, individual plan guidance, non-marketplace premium explainers, 1099 worker insurance guidance and other tools. - Benefitra says the new compare tool is one more way to help self-employed buyers weigh cost, coverage and network risk before choosing a plan.