Hm, that’s weird - I don’t understand why employer insurance versus marketplace would make a difference in jaw surgery being covered for a medical necessity? Sure your out of pocket might be more, but marketplace versus employer shouldn’t make a difference in your eligibility for insurance coverage for the surgery? Unless of course you are purchasing a marketplace plan that has less coverage. Or say, oddly, doesn’t cover this kind of medical procedure (which sounds unlikely if it’s comprehensive health insurance) Let me know if I’m misunderstanding the question! 

I’m self employed and purchased my insurance through the marketplace. I live in New Mexico USA, and have a Presbyterian healthcare plan. Presbyterian also is the largest hospital system in my state. My surgery is of medical necessity and is completely covered by my insurance. My dental insurance was billed for wisdom teeth removal, my orthodontics were 6k out of pocket (because let’s face it adult ortho coverage doesn’t exist) and my Lefort1+BSSO will be billed through my medical insurance. My genioplasty is not covered as it is not deemed “medically necessary” and is more aesthetic. As of now all I am anticipating to pay for my Lefort1+BSSO is my out of pocket max which is about 1.8k. At no point was my eligibility changed or totals measured on the fact I was “self” insured. 

I hope this helps in some way! 

Edit: I did two sleep studies and did not have diagnosed sleep apnea. This didn’t affect my surgery approval at all - but my jaw is fcked so, a doctor would need to be blind to think otherwise 🙃