Frequently Asked Questions

Your deductible is the amount you pay for covered healthcare services before your insurance starts paying. Your out-of-pocket maximum is the most you'll pay during a policy period (usually one year) before your insurance covers 100% of covered services. The out-of-pocket maximum includes your deductible, copays, and coinsurance, but not your monthly premiums.

The annual Open Enrollment Period for Marketplace plans typically runs from November 1 through January 15. However, you may qualify for a Special Enrollment Period if you experience certain life events like losing health coverage, getting married, having a baby, or moving to a new area. Contact us to determine if you qualify for special enrollment.

Premium tax credits are available to individuals and families with household incomes between 100% and 400% of the federal poverty level (though the upper limit has been temporarily removed). Your eligibility depends on your estimated income for the year, household size, and whether you have access to affordable employer-sponsored coverage. We can help you estimate your subsidy and optimize your tax situation.

It depends on the plan's provider network. Each insurance plan has a network of doctors, hospitals, and healthcare providers. Before choosing a plan, check if your preferred providers are in-network. We can help you verify provider networks and find plans that include your doctors.

Your Initial Enrollment Period begins three months before the month you turn 65 and continues for three months after. Missing this window can result in permanent late enrollment penalties. If you're still working and covered by an employer plan with 20+ employees, you may be able to delay enrollment without penalty. We can help you navigate the timing based on your specific situation.

Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare offered by private insurers. It includes Part A, Part B, and usually Part D prescription coverage, often with extra benefits like dental and vision. Medigap (Medicare Supplement) works alongside Original Medicare to help pay the costs Medicare doesn't cover, like deductibles and copays. You can't have both Medicare Advantage and Medigap at the same time.

While not required, we generally recommend enrolling in Part D even if you don't currently take medications. If you go without creditable prescription drug coverage for 63 days or more, you'll pay a late enrollment penalty that increases your premiums permanently. It's often less expensive to maintain basic Part D coverage than to pay the penalty later if you need it.

Your health insurance impacts your taxes in several ways. If you're self-employed, you may deduct 100% of your premiums. If you receive premium tax credits through the Marketplace, you'll reconcile them on your tax return. HSA contributions are tax-deductible. You may also deduct unreimbursed medical expenses exceeding 7.5% of your adjusted gross income. We help you understand and maximize these tax benefits.

A Health Savings Account (HSA) is a tax-advantaged savings account available if you have a high-deductible health plan. Contributions are tax-deductible, earnings grow tax-free, and withdrawals for qualified medical expenses are tax-free. HSAs offer the best tax benefits of any account, and unlike FSAs, the money rolls over year to year. After age 65, you can use it like a traditional IRA. If you're relatively healthy and can afford to save, an HSA is often an excellent choice.

It depends on your situation. Self-employed individuals can typically deduct 100% of health insurance premiums for themselves, their spouse, and dependents as an adjustment to income. If you're an employee, you can only deduct premiums (along with other medical expenses) if they exceed 7.5% of your adjusted gross income and you itemize deductions. Medicare premiums are treated similarly to other health insurance for deduction purposes.

Premium tax credits reduce your monthly health insurance costs based on your estimated household income. You can choose to receive them in advance (lowering your monthly premium) or claim them when you file your taxes. When you file, you'll reconcile the credit based on your actual income. If you received too much, you may owe money back; if you received too little, you'll get a refund. Changes in income, household size, or marital status should be reported to avoid surprise tax bills.

Our consultations and enrollment assistance are provided at no direct cost to you. We're compensated by insurance carriers when you enroll in coverage through us. This commission structure doesn't increase your premiums—you pay the same price whether you work with us or enroll directly. Our value is in providing unbiased guidance and ongoing support.

We continue to support you after enrollment. We're available to answer questions about your coverage, help with claims issues, assist during annual enrollment periods, and adjust your coverage when life changes occur. Think of us as your long-term insurance partner, not just someone who signs you up and disappears.

We work with a wide range of reputable insurance carriers and have access to the Health Insurance Marketplace and Medicare plans. This allows us to provide truly unbiased recommendations based on your needs rather than being limited to a single company's products. We'll compare options from multiple carriers to find the best fit for your situation and budget.