Open Enrollment (annual)
Typically Nov–Jan. Enroll, renew, or change plans for the new year.
Special Enrollment Period (SEP)
Qualifying life events allow mid‑year enrollment: losing other coverage, moving, marriage/divorce, birth/adoption, income change, COBRA ending.
What you may need
Not sure if you qualify? We can review your situation and timelines.
Typically Nov–Jan. Enroll, renew, or change plans for the new year.
Special Enrollment Period (SEP)
Qualifying life events allow mid‑year enrollment: losing other coverage, moving, marriage/divorce, birth/adoption, income change, COBRA ending.
What you may need
- Proof of the qualifying event (notice or letter)
- Household info (names, DOBs, addresses)
- Estimated annual income for subsidy screening
Not sure if you qualify? We can review your situation and timelines.
Premium Tax Credits (PTCs)
Lower your monthly premium when you buy a Marketplace plan and your estimated income fits the rules.
Cost‑Sharing Reductions (CSRs)
If eligible and you choose a Silver plan, CSRs can reduce deductibles, copays, and out‑of‑pocket maximums.
How we estimate
We review your household size and projected Modified Adjusted Gross Income, then show options on‑ and off‑exchange to compare total costs.
Example: A family of 3 with mid‑range income may qualify for a significant PTC; pairing that with an appropriate Silver plan can improve predictability.
Lower your monthly premium when you buy a Marketplace plan and your estimated income fits the rules.
Cost‑Sharing Reductions (CSRs)
If eligible and you choose a Silver plan, CSRs can reduce deductibles, copays, and out‑of‑pocket maximums.
How we estimate
We review your household size and projected Modified Adjusted Gross Income, then show options on‑ and off‑exchange to compare total costs.
Example: A family of 3 with mid‑range income may qualify for a significant PTC; pairing that with an appropriate Silver plan can improve predictability.
HMO: Lower premiums; must use in‑network providers; referrals usually required.
EPO: In‑network only (no out‑of‑network), no referrals in most cases.
PPO: Broadest choice; can use out‑of‑network at higher cost; usually higher premiums.
Check providers & prescriptions
EPO: In‑network only (no out‑of‑network), no referrals in most cases.
PPO: Broadest choice; can use out‑of‑network at higher cost; usually higher premiums.
Check providers & prescriptions
- We verify your doctors and facilities are in‑network for each plan.
- We confirm your medications are on the plan’s formulary and estimate typical copays.
- We review referral rules and how to handle out‑of‑network situations.
What you get at no extra cost
Also exploring dental or vision? See our options on the Dental & Vision page.
- Plan comparisons on- and off-exchange with clear total-cost view.
- Network and formulary checks for your doctors and prescriptions.
- Subsidy screening and application support.
- Ongoing help with billing issues, ID cards, and renewals.
Also exploring dental or vision? See our options on the Dental & Vision page.
Do I have to buy on the Marketplace to get subsidies?
No. You must enroll through the Marketplace to receive Premium Tax Credits and CSRs. We can handle the application with you.
How accurate does my income estimate need to be?
Use your best projection for the year. You’ll reconcile at tax time. We help you document a reasonable estimate and update if things change.
Can I cover my dependents if they have separate insurance?
Yes, but coordination of benefits applies. We’ll review costs and whether it makes sense to split coverage.
Are out‑of‑network services ever covered?
Generally no for HMO/EPO, sometimes partially for PPO. Emergencies are treated as in‑network. We’ll explain exceptions.
What’s the difference between deductible, copay, and coinsurance?
Deductible: what you pay before coverage. Copay: flat fee per service. Coinsurance: percentage after deductible. OOP max caps your total spend.
How do prescriptions work?
Plans use formularies with tiers and prior auth rules. We’ll check your meds and estimate typical costs.
What if I miss Open Enrollment?
You may qualify for a Special Enrollment Period after certain life events. Ask us to review your eligibility.
Are short‑term plans an option?
Short‑term plans can be limited and exclude pre‑existing conditions. We’ll show pros/cons and compliant alternatives.
No. You must enroll through the Marketplace to receive Premium Tax Credits and CSRs. We can handle the application with you.
How accurate does my income estimate need to be?
Use your best projection for the year. You’ll reconcile at tax time. We help you document a reasonable estimate and update if things change.
Can I cover my dependents if they have separate insurance?
Yes, but coordination of benefits applies. We’ll review costs and whether it makes sense to split coverage.
Are out‑of‑network services ever covered?
Generally no for HMO/EPO, sometimes partially for PPO. Emergencies are treated as in‑network. We’ll explain exceptions.
What’s the difference between deductible, copay, and coinsurance?
Deductible: what you pay before coverage. Copay: flat fee per service. Coinsurance: percentage after deductible. OOP max caps your total spend.
How do prescriptions work?
Plans use formularies with tiers and prior auth rules. We’ll check your meds and estimate typical costs.
What if I miss Open Enrollment?
You may qualify for a Special Enrollment Period after certain life events. Ask us to review your eligibility.
Are short‑term plans an option?
Short‑term plans can be limited and exclude pre‑existing conditions. We’ll show pros/cons and compliant alternatives.
Tell us about your household, doctors, and prescriptions—we’ll match plans and confirm networks. Expect a response within one business day. Your information stays private.
