ACA Marketplace plans
Individual and family coverage bought through the federal or state Marketplace. If you don’t have a plan through an employer, this is usually where the search starts and where the biggest savings are.
Is this you?
If any of these sound familiar, this is worth a conversation.
- You don’t have coverage through an employer
- You’re a US citizen or lawfully present
- You live in one of the 30+ states I’m licensed in
- You’re enrolling during Open Enrollment, or have had a qualifying life event
Outside Open Enrollment you can only enroll with a qualifying life event, which is a change the Marketplace recognizes as opening a special enrollment window. Common ones: losing other coverage, moving to a new ZIP code or county, marriage or divorce, a birth or adoption, turning 26, becoming a U.S. 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.
What it covers
What you can expect from this kind of plan.
- All ten essential health benefits, including preventive care
- Pre-existing conditions covered, and they can’t raise your premium
- Prescription coverage, though drug tiers vary a great deal by plan
- Children can stay on your plan until they turn twenty-six
The honest version
Premium tax credits are based on the income you expect next year and your household size. Many households qualify for a substantial monthly credit; some qualify for cost-sharing reductions on Silver plans on top of that. Getting the income estimate right is the single most valuable part of this conversation.
One plan for everyone isn’t always the cheapest answer
Often the adults belong on a Marketplace plan while the children qualify for CHIP, and nobody tells you that unless you ask. Household size changes what you qualify for, so a family of five and a family of three on the same income can land in very different places. I run the whole-family plan and the split, then you decide.
- Well-child visits, immunizations and children’s dental
- A side-by-side of one family plan against a split arrangement
- CHIP screening for the children even when you don’t qualify
- A check on whether a new baby, adoption or marriage opened a window
Medicaid and CHIP eligibility is decided by your state, and there’s no enrollment deadline. You can apply any month of the year. Neither pays me a commission.
See Medicaid & CHIP guidance
Find out where you actually stand
Fifteen minutes on the phone. I check what you qualify for, price the options side by side, and you decide with the numbers in front of you. Nothing to sign, and the quote is free.
Tell me what matters
Who needs covering, which doctors you want to keep, what prescriptions you take, and what you can comfortably pay each month.
Understand your options
Plans side by side: total cost, networks, benefits, limits, and the actual plan documents. The premium is only one number of several.
Choose what fits
You move forward only once the tradeoffs make sense to you. Then I handle the paperwork and stay reachable all year.
I stay on it
ID card problems, a denied claim, a baby, a move, renewal season. You call the same person who set your plan up.
Let’s clarify your options together
Bring your doctors, your prescriptions and a rough sense of next year’s income. Leave knowing exactly what you qualify for and what it’ll cost you.