RBP plans — Employer-style pricing without an employer — costs pegged to Medicare rates.
Reference-Based Pricing (RBP) plans set reimbursement rates based on a multiple of Medicare rates (typically 120–200%) rather than negotiated carrier networks. This can mean dramatically lower costs but also more provider negotiation. Less common on the individual marketplace but growing in the self-employed and small group space.
RBP in plain English.
Instead of a traditional network, the plan pays providers based on a percentage of Medicare rates (usually 120–200%). Any willing provider can accept this payment. You may need to negotiate with providers who want to charge more. No traditional network — any provider can participate.
Best for:
Trade-offs to know:
Carriers offering RBP plans.
Cost range: $200–$600/mo (no subsidies — off-exchange). Your agent compares total cost across all available carriers in your ZIP.
Twelve minutes, scripted.
We'll lay out exactly what your agent will ask, in what order, and why - so you know what to have in front of you before you pick up the phone.
A licensed agent picks up
No phone tree, no transfers, no hold music. Median answer time: 38 seconds.
They ask your ZIP and the ages of anyone covered
So they can pull plans actually available in your state - and confirm the right metal tier for your household.
They ask which doctors and meds matter to you
So they can rule out plans that don't include your providers or formulary. This is the step the marketplace skips.
They show you 3–5 plans side-by-side
Premium, deductible, max out-of-pocket, network size, and a plain-English read on what each gets you.
You pick - they enroll you on the call
Same call. Effective date is typically the 1st of next month. Confirmation by email and SMS within an hour.
You hang up insured
No follow-up sales calls, no info sold to anyone. If you change your mind, we have a 30-day support window - same agent.
You pay nothing. Ever.
We're paid a flat commission by the carrier when you enroll - the same amount whether you pick a BlueCross PPO or an Ambetter HMO. We have zero incentive to push you toward anything but the plan that fits. We don't sell your information. We don't email you for weeks.
Common questions about RBP plans.
RBP plans pay providers based on a multiple of Medicare rates (usually 120–200%) instead of using negotiated carrier networks. This can mean lower costs but requires more active engagement from you.
No — RBP plans are off-exchange only. This means no ACA subsidies. They're most common in the self-employed and small group market.
Many providers accept Medicare-based rates, but not all. You may need to negotiate or find willing providers. Your agent explains the process.
Often, yes — if you're healthy and comfortable with some provider negotiation. But without subsidies, total cost can be higher for people who qualify for ACA tax credits.
If you qualify for subsidies, marketplace plans (with an HMO, PPO, or EPO) are almost always cheaper. RBP makes more sense for high earners who don't qualify for subsidies. Your agent compares both.
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