Health insurance FAQ
If something here still isn’t clear, that’s what the call is for.
What actually happens on the call?
Fifteen minutes. Bring the doctors you want to keep, any prescriptions you take, and a rough income estimate for next year. Nothing to sign, no obligation.
What does this cost me?
Nothing. Brokers are paid a commission by the carrier when a plan is issued. Your premium is the same whether you enroll through me or directly on your own.
HMO, PPO, EPO — what’s the difference?
Those three letters describe one thing: how much freedom you have to choose doctors, and what happens if you go outside the plan’s network.
| HMO | PPO | EPO | |
|---|---|---|---|
| Out-of-network care | Not covered, except an emergency | Covered, at a higher cost to you | Not covered, except an emergency |
| Primary care doctor required | Yes | No | Usually not |
| Referral to see a specialist | Yes | No | Usually not |
| Typical premium | Lowest of the three | Highest of the three | In between |
| Network size | Usually local and narrow | Usually the widest | Narrow, but no referrals |
Swipe the table sideways to see all three →
In plain terms: an HMO is the cheapest and the strictest. You pick a primary care doctor and go through them. A PPO costs the most and asks the least: no referrals, and it still pays something out of network. An EPO sits in between. No referrals needed, but step outside the network and you pay the whole bill yourself.
There’s a fourth, POS, which blends the two. You need a referral like an HMO, and out-of-network care is still covered at a higher cost like a PPO. The letters matter much less than one question: are your doctors in that plan’s network this year? That’s what I check on the call.
Can I keep my doctor?
Often, but it has to be checked before you enroll, not after. Networks change every plan year, and a doctor who was in network last year may not be this year.
What if I don’t qualify for a subsidy?
You still have options worth comparing properly. Subsidy eligibility depends on household size and expected income, and small changes to that estimate can move you across a threshold.
When can I enroll?
It depends which market you’re in. There are three answers, and only one of them has a deadline you can miss.
The one window each year when anyone can enroll in an ACA plan, no reason required. Enroll by December 15 and coverage starts January 1. Enroll between December 16 and January 15 and it starts February 1. Miss January 15 and the Marketplace closes to you until next November.
Outside Open Enrollment you need a life change the Marketplace recognizes: losing other coverage, moving to a new ZIP code or county, marriage or divorce, a birth or adoption, turning 26, becoming a citizen, or leaving incarceration. You generally have 60 days from the event, or 90 days if you lost Medicaid or CHIP, and a loss of coverage counts from up to 60 days before it ends, so you can line the new plan up in advance. Voluntarily dropping coverage doesn’t count.
Medically underwritten private plans aren’t tied to the Marketplace calendar, so there’s no window to miss and no life event needed. Underwriting decides it, not a date. The carrier reviews your health history and can approve you, price you, or decline you on that basis. Medicaid and CHIP are open year-round too, with eligibility decided by your state.
If you’re reading this outside Open Enrollment and nothing on the middle list applies to you, the private market is usually the live option. That’s worth a call rather than a guess.