Why are Florida premiums projected to increase in 2026?

Rising medical costs, higher service utilization, expensive prescription drugs, and possible expiration of enhanced ACA subsidies are driving Florida insurers to file for higher 2026 rates.

When do 2026 rates take effect in Florida?

For ACA marketplace plans, new 2026 rates apply starting January 1, 2026. Open Enrollment later in 2025 is when most Floridians choose coverage for the year ahead.

How can I reduce health insurance costs before 2026?

Shop early, compare ACA vs private PPOs, check subsidy eligibility, and optimize deductible and network fit. RKA can pre-screen underwriting and confirm provider access.

Can I keep my current doctors in Texas?

Often, yes. We check your doctors against the exact plan network you choose—before enrollment—so there are no surprises.

How do Marketplace and Private PPO costs differ?

Marketplace can be cheapest if your income qualifies for credits. Private PPOs don’t use ACA credits—pricing is based on age, ZIP, benefits, and network size.

Send your provider list and meds. We’ll verify your doctors, compare Marketplace vs Private PPO side-by-side, and show clear costs. No pressure—just answers.

What health insurance options do Florida self-employed have in 2025?

Common options include ACA Marketplace plans (with possible premium tax credits), private medically underwritten PPOs for eligible applicants, association/short-term options where appropriate, and spouse or group coverage if available.

How do I know if I qualify for ACA subsidies as self-employed?

Subsidies are based on household size and estimated 2025 Modified Adjusted Gross Income (MAGI). Many self-employed qualify—especially with variable income. An advisor can model your income scenarios and estimate credits.

Are private PPOs available for self-employed Floridians?

Yes. Private, medically underwritten PPOs may be available to eligible applicants and can offer broad networks and competitive premiums. Eligibility depends on health history and carrier guidelines.

Should I use an HSA in 2025?

If you enroll in an HSA-eligible plan, contributions may reduce taxable income and build a medical reserve. Whether it makes sense depends on your cash flow and expected medical usage.

Can RKA verify my doctors and prescriptions?

Yes. We confirm provider participation and check formulary tiers so you understand costs before you enroll.

Can I get health insurance outside Open Enrollment?

Yes. You may qualify for a Special Enrollment Period after life events (loss of coverage, marriage, birth/adoption, move). Some applicants may use an income-based SEP in certain situations. Private, medically underwritten PPOs may also enroll year-round if eligible.

What qualifies me for a Special Enrollment Period (SEP)?

Common QLEs include: loss of qualifying coverage, marriage/divorce, birth/adoption, moving residence, gaining lawful presence, or major income changes affecting eligibility. Most SEPs last 60 days from the event.

Are there year-round options if I don’t have a QLE?

For eligible applicants, certain private medically underwritten PPOs can start any month after underwriting and network checks. Availability varies by state and health history.

When will my coverage start?

Marketplace plans typically start the first of the month after you select a plan by the monthly cutoff. Private PPOs begin after approval and chosen effective date—often the 1st or 15th of a month.

When is Open Enrollment for individual health insurance?

Open Enrollment typically occurs in late fall through mid-January for coverage starting the following January. Some state-based Marketplaces set different start/end dates. Check your current year’s dates or ask RKA to confirm for your ZIP.

What if I miss Open Enrollment?

You’ll need a Qualifying Life Event (QLE)—like loss of coverage, marriage, birth/adoption, or moving—to trigger a Special Enrollment Period. Certain income ranges may also qualify you for a monthly SEP in some states.

Can I enroll in a private PPO outside Open Enrollment?

Some private, medically underwritten PPO options may be available year-round for eligible applicants. We’ll pre-screen underwriting and verify provider access.

When does my new plan start?

Marketplace plans selected by the monthly cutoff generally begin the first day of the following month. Dates can vary; we’ll confirm effective dates when we enroll you.

Why shouldn’t I go solo during Open Enrollment?

Navigating enrollment alone may limit your options and lead to higher premiums. Licensed advisors know both ACA and private PPO markets, helping you avoid costly mistakes and uncover better coverage.

How can a licensed advisor save me money?

Licensed advisors compare ACA subsidies and private underwriting options. Healthy households may qualify for lower premiums through private PPOs, while income-based savings apply to ACA plans.

When are the Open Enrollment 2025 deadlines?

Open Enrollment runs November 1, 2024 – January 15, 2025. Apply by December 15 for January 1 coverage, or by January 15 for February 1 coverage.

What’s the difference between HMO, PPO, EPO, and POS networks?

HMOs usually require a primary care physician and referrals, and generally do not cover out-of-network care except emergencies. PPOs allow out-of-network coverage (often at higher cost) and typically don’t require referrals. EPOs are similar to HMOs but without referrals; they usually don’t cover out-of-network care beyond emergencies. POS plans blend HMO and PPO features and may require a PCP and referrals but include some out-of-network benefits.

Do PPOs always have nationwide access?

Not always. Many PPOs use regional or national networks, but access varies by carrier and product. Always verify your specific doctors and hospitals.

Will an HMO cover me when I travel?

HMOs typically cover emergencies out of area, but non-emergency care must be in-network and authorized. If you travel often, confirm how the plan treats away-from-home care.

What is prior authorization?

Prior authorization means the plan must approve certain services before you receive them. Without approval, the claim can be denied even if the provider is in network.

What did Biden’s new short-term insurance rule change?

Starting in September 2025, short-term medical plans are limited to 3 months with only a 1-month renewal, reducing their usefulness for long-term coverage.

Who will be most affected by this change?

Self-employed individuals, contractors, and those who relied on short-term medical plans may struggle to maintain continuous coverage.

What are my alternatives to short-term plans?

ACA Marketplace plans guarantee acceptance regardless of health conditions, while medically underwritten PPOs may offer lower costs if you’re healthy. Employer coverage is another option if available.

What’s the core difference between a PPO and an HMO?

PPOs allow specialist access without referrals and include out-of-network benefits (at higher cost). HMOs emphasize in-network care, typically require a PCP and referrals, and generally exclude out-of-network care except emergencies.

Which is better for small, multi-state teams?

PPOs often fit distributed or traveling teams thanks to broader networks and out-of-network benefits. Always verify specific doctors and facilities.

Will a PPO always be more expensive?

Not always. Total annual cost depends on premiums, employer contribution strategy, and expected usage. Network fit can prevent costly out-of-network surprises.

What income counts for ACA subsidy eligibility?

The Marketplace uses Modified Adjusted Gross Income (MAGI)—generally AGI plus nontaxable Social Security, tax-exempt interest, and certain foreign income. Household size and MAGI determine premium tax credits.

How do I avoid paying back subsidies at tax time?

Report income changes to the Marketplace promptly, keep estimates realistic, and review quarterly if self-employed. At tax time, reconcile advance credits on Form 8962 using Form 1095-A.

I’m self-employed—how often should I update income?

Check monthly and update when your year-to-date profit changes your annual estimate meaningfully. Consider setting aside part of any premium savings for potential reconciliation.

What if I underestimated income?

You may owe back some or all of the advance credits, subject to repayment caps based on final income. Updating mid-year helps minimize large year-end adjustments.

Do life changes affect subsidies?

Yes—marriage, divorce, a new dependent, or changes in residence or job can change eligibility. Report these events within 30 days to keep your plan and credits accurate.

Robert Adams 9/15/25 Robert Adams 9/15/25

Texas 2026 Health Insurance Premiums: What to Do Before Prices Jump

Texas marketplace insurers are signaling higher 2026 premiums. Here’s how to lower costs—plan timing, private PPO options, and Rx strategy

Texas 2026 Health Insurance Premiums: What to Do Before Prices Jump | RKA

Texas • Premium Watch

Texas 2026 Health Insurance Premiums: What to Do Before Prices Jump

Fast take: Texas marketplace insurers have filed for notable premium increases for 2026. Costs are being driven by higher medical prices, utilization, and pricey drugs. If enhanced federal subsidies expire after 2025, some households could see larger net costs. Here’s how to prepare—and options to compare now.

Get Quotes Now Book an Appointment

What’s behind the increase?

Medical inflation & utilization: Providers and hospitals are charging more, and people are using more care.
High‑cost drugs: GLP‑1 medications and other specialty drugs are materially affecting trend.
Policy uncertainty: If enhanced ACA subsidies end after 2025, net premiums may rise for many families.

Moves to consider now

1) Audit your plan type

Check whether your current plan fits your usage. If you travel or work across state lines, a nationwide PPO may offer better access and predictable costs on the road.

2) Time your enrollment

Open Enrollment later this year sets your 2026 price. We can compare multiple options side‑by‑side—including marketplace plans and other eligible choices—so you don’t overpay.

3) Consider private PPO with medical underwriting

For healthy individuals and families, private, medically underwritten PPO options can offer lower premiums than unsubsidized ACA plans, broad nationwide PPO access, and predictable day‑to‑day costs. Eligibility depends on underwriting; we’ll pre‑screen quickly and confirm network access so you know if it’s a fit.

4) Rx strategy

Know your drug tiering and prior auth rules. When appropriate, ask about generics, patient assistance, or discount programs to lower out‑of‑pocket costs.

How RKA helps Texans

Plan matching: We compare options from major carriers and traveler‑friendly PPOs.
Cost projection: We estimate your annual cost with premiums + likely usage so you choose confidently.
Fast enrollment: We can place coverage quickly and help you avoid gaps.

Get Quotes Now Book an Appointment

Quick FAQs

Will 2026 marketplace prices impact my plan right away?

They typically apply starting January 1, 2026. The choices you make during Open Enrollment later this year will determine your 2026 costs.

Are there alternatives if I’m healthy and want lower premiums?

Depending on eligibility, some households may consider different plan structures. We’ll walk you through options that fit your needs and travel patterns.

Can RKA verify if my doctors are in‑network?

Yes—send us the names and we’ll confirm network status and expected costs before you enroll.

For education only; benefits and eligibility vary by carrier and state. Always review official plan documents.

Robert Adams 9/11/25 Robert Adams 9/11/25

Remembering 9/11

On September 11th, 2001, life seemed to stop. As a sophomore in South Jersey just hours from NYC, I watched in disbelief as the towers fell. My family’s service with the Longport NJ Volunteer Fire Dept at Ground Zero showed me that unity and service are responsibilities we all share. We will never forget.

Remembering 9/11 | RKA Insurance Advisors

Reflection • September 11th

Remembering 9/11

“We will never forget.”

September 11th, 2001 is a day forever etched in my memory. I was a sophomore in high school in South Jersey—just two and a half hours from New York City. That morning, life seemed to stop. Everyone was glued to the television, watching in disbelief as the towers crumbled live on the screen. The silence in our community was deafening, broken only by the sounds of worry, grief, and prayers. It was something no human has ever witnessed. No one knew what to do, what to say.

For my family, service to others has always been a foundation. Members of the Longport, NJ Volunteer Fire Department went to Ground Zero in the days that followed, helping with rescue and cleanup efforts. Their courage—and the unity I saw across our nation in those days—left a lasting impression on me. It reinforced the belief that no matter the challenge, we are stronger when we come together in service of one another.

Today, as we remember those we lost and honor the bravery of first responders and everyday heroes, I am reminded that unity and service are not just values—they are responsibilities. On this day, we pause not only to remember but to recommit ourselves to looking out for one another.

— Robert Adams
RKA Insurance Advisors

Robert Adams 9/8/25 Robert Adams 9/8/25

Florida 2026 Health Insurance Premiums: What to Do Before Prices Jump

Florida health insurance premiums are projected to rise in 2026. Learn what’s driving the increases, how subsidies and PPO options compare, and the steps you can take now to protect your budget.

Florida 2026 Health Insurance Premiums: What to Do Before Prices Jump | RKA

Florida • Premium Watch

Florida 2026 Health Insurance Premiums: What to Do Before Prices Jump

Fast take: Florida insurers are signaling notable rate increases for 2026. Rising medical costs, expensive prescriptions, and potential loss of federal subsidies mean many households could face higher bills. Here’s how to prepare now.

Why are rates climbing?

Medical inflation: Hospitals and providers are charging more each year.
Prescription costs: High-cost drugs like GLP-1s are putting pressure on premiums.
Policy shifts: Enhanced ACA subsidies could expire after 2025, raising net costs for many Floridians.

Smart moves for Florida households

1) Audit your plan type

Does your plan still fit? If you travel or want wider access, a PPO may reduce out-of-network surprises and give better provider choice.

2) Plan enrollment timing

Open Enrollment later this year locks in your 2026 premiums. We’ll run side-by-side comparisons of ACA marketplace plans and private options so you don’t overpay.

3) Explore private PPOs

For healthy applicants, private, medically underwritten PPOs may deliver lower premiums, broad provider networks, and more predictable costs. RKA will pre-screen and verify eligibility quickly.

4) Prescription strategy

Check formulary tiers, ask about generics, and use discount programs or assistance where available to lower Rx spending.

How RKA supports Floridians

Custom plan matching: We compare major carriers and PPO alternatives.
Cost projection: Annual cost estimates include both premiums and expected usage.
Fast enrollment: We help you secure coverage quickly without gaps.

Quick FAQs

When will Florida’s 2026 rates affect me?

They apply starting January 1, 2026. You’ll choose coverage during Open Enrollment late 2025.

Are private PPOs available in Florida?

Yes—if eligible, private PPOs may offer broad networks and lower premiums than unsubsidized ACA plans.

Can RKA confirm my doctors are covered?

Absolutely. Provide your provider list, and we’ll confirm network access before you switch plans.

For education only; benefits and eligibility vary by carrier and state. Always review official plan documents.

Robert Adams 9/5/25 Robert Adams 9/5/25

COBRA vs Marketplace vs Private PPO: What to Do Right After You Lose Employer Coverage

Quick guide to COBRA vs Marketplace vs Private PPO—costs, networks, and when each wins. We’ll verify your doctors and show clear prices.

COBRA vs Marketplace vs Private PPO: What to Do Right After You Lose Employer Coverage

Laid off, new job, or between jobs? Here’s the fast, practical guide—costs, networks, deadlines, and how to decide in minutes. We’ll verify your doctors and show clear costs.

COBRA (keep your old plan)

Same network/benefits you already know.
Usually most expensive (you pay full premium + 2%).
Time-limited (18 months); retroactive if elected on time.
Good when in treatment and changing plans is risky.

Marketplace (Government)

May be cheapest if your income qualifies for credits.
Many plans are HMO/EPO; referrals are common.
Mid-year move allowed due to loss of coverage.
Credits reconcile at tax time—under-reporting income can create payback.

Private PPO (Licensed Access)

Nationwide PPO when eligible; keep specialists/hospitals.
Typically no referrals; fewer hoops.
Advance premium tax credits do not apply to Private PPOs.
Pricing = age, ZIP, benefits, and network.
Great when you travel or want doctor choice.

What tends to cost more—and why

Why COBRA is often pricey

You pay the entire employer premium + 2% admin fee.
Large-group plan designs can carry higher OOP maxes.
No income-based help.

How non-Marketplace Private PPO prices

Based on age, ZIP, network size, and benefits.
Good fits: provider choice, travel, specialist access, fewer referrals.
We verify your doctors before you switch.

How to decide in minutes

Pick COBRA if…

You’re mid-treatment and can’t risk network changes.
You can stomach short-term higher premiums.
You need exactly the same plan and doctors right now.

Pick Private PPO if…

You want nationwide PPO and typically no referrals.
You travel, use specialists, or dislike gatekeepers.
Credits don’t help you—or you prefer not to use them.

We’ll compare all three with your doctors and meds, then show clear side-by-side costs.

Want the best post-employer fit in your ZIP?

We’ll verify your doctors and meds, compare COBRA vs Marketplace vs Private PPO, and show clear costs. No pressure—just answers.

Get Free Quotes Book a Call

FAQ

How long do I have to elect COBRA?

Generally 60 days from the notice. If elected in time, coverage can be retroactive to the loss date (you’d owe premiums).

Can I switch from COBRA to other coverage later?

Yes. Marketplace: during Open Enrollment (or another qualifying event). Private PPO: typically year-round if you’re eligible. We’ll time it so there are no gaps.

Do Private PPOs use ACA tax credits?

No. Private PPOs don’t use ACA advance premium tax credits (APTC). Marketplace plans do, and those credits reconcile at tax time—under-reporting income can create payback.

How do I know if my doctors are covered?

Send your provider list. We check your doctors against the specific plan network you choose so you know before you switch.

How do we start?

Share your doctors, prescriptions, and budget. We’ll map options and enroll you quickly and compliantly.

This overview is educational, not tax or legal advice. Availability varies by state and carrier. Eligibility and enrollment subject to plan terms.

Robert Adams 9/4/25 Robert Adams 9/4/25

New to Texas? Health Insurance—Fast Guide (Marketplace vs Private PPO)

Texas health insurance, made simple: Marketplace credits vs Private PPO, how networks differ, start dates, and what to verify first. We’ll check your doctors and show clear costs.

New to Texas? Health Insurance—Fast Guide (Marketplace vs Private PPO)

Just moved to TX? Here’s how coverage works, what proof you’ll need, and how to keep your doctors. We’ll verify providers and show clear costs—no pressure.

Marketplace (Government)

Can be cheapest if your income qualifies for credits.
Many plans are HMO/EPO; referrals are common.
Options vary by county/ZIP.
Move = special enrollment (time-limited). Credits reconcile at tax time.

Private PPO (Licensed Access)

Nationwide PPO access when eligible; keep key doctors/hospitals.
Typically no referrals; fewer hoops for specialists.
Pricing isn’t tied to ACA income credits.
Good for travel, provider choice, and specialist access.

We run both paths side-by-side with your doctors and prescriptions, so you pick based on fit—not guesswork.

What to do first (takes 5 minutes)

1) Gather quick proof

New TX address (lease, closing docs, utility, USPS change).
Prior coverage details if switching.

2) List providers & meds

Doctors, specialists, hospitals you want to keep.
Current prescriptions (name + dosage).

3) Decide priorities

Lowest premium vs. broad network.
Referrals OK or prefer no referrals?
Travel out of state?

What drives cost in Texas

Marketplace

Income & household size (for tax credits).
Plan level & network (HMO/EPO common).
County—options can change across county lines.

Private PPO

Age, ZIP, benefit level, and network size.
No ACA credits; premiums are straightforward.
Great when keeping providers is the priority.

Simple decision guide

Choose Marketplace if…

Your income qualifies for strong credits.
You’re OK with HMO/EPO rules & referrals.
Lowest premium is the top priority.

Choose Private PPO if…

You want broad, often nationwide PPO access.
You prefer no referrals to see specialists.
Keeping specific doctors/hospitals matters most.

New to Texas? Let’s lock the best fit in your ZIP.

We’ll verify your doctors and meds, compare Marketplace vs Private PPO, and show clear costs. No pressure—just answers.

Get Free Quotes Book a Call

FAQ for recent Texas moves

Do I get a special enrollment window when I move to Texas?

Yes—moves generally create a time-limited window to enroll. We’ll confirm timing and options for your county and situation.

What proof of my move do I need?

Usually a new Texas address document (lease/closing/utility/USPS change). We’ll tell you exactly what’s accepted before you apply.

When will coverage start?

Start dates depend on when you enroll and which route you choose. We’ll show the earliest eligible effective date and time the switch so there’s no gap.

Can I keep my current doctors?

Often, yes. We check your doctors against the exact plan network you choose—before you enroll—so there are no surprises.

What if I’m coming from COBRA?

You can stay on COBRA or switch to Marketplace/Private PPO. We’ll compare costs and timing so you only pay for what you need.

This overview is educational, not tax or legal advice. Availability and rules vary by carrier and county. Eligibility and enrollment subject to plan terms.

Robert Adams 9/1/25 Robert Adams 9/1/25

Skip the Government Marketplace: How Private PPO Plans Actually Work

Fast guide to non-Marketplace Private PPOs—how they bill, who they fit, and what to verify first. We’ll confirm your doctors, compare options, and show clear costs.

Skip the Government Marketplace: How Private PPO Plans Actually Work

Prefer private, licensed-access coverage? Here’s the fast, practical guide—what it is, how it bills, and how to check if it fits your doctors, travel, and budget.

Why some people skip the Marketplace

Common reasons

Keep specific doctors/hospitals. Many Marketplace options are HMO/EPO with referrals.
Travel flexibility. Want nationwide, not just local networks.
Fewer gatekeepers. Prefer no referrals for specialists or imaging.
Income too high for meaningful subsidies—or you don’t want tax-credit involvement.

Balanced reality check

If your income qualifies, Marketplace can be the cheapest route.
Credits reconcile on your tax return; under-reporting income can create payback.
Private PPOs skip subsidies entirely—pricing is based on age, ZIP, benefits, and network.

Bottom line: Choose based on doctors + travel + total cost, not labels. We verify both paths before you switch.

How Private PPO actually works

Private PPO (Licensed Access)

Nationwide PPO access in eligible networks—keep your specialists and preferred hospitals.
No referrals for specialists (typical), fewer hoops to schedule care.
Enroll through a licensed agent; options vary by state and carrier.
Premiums aren’t tied to ACA income credits.

What to verify first

Your exact doctors and facilities are in-network (we check for you).
Copays vs coinsurance on high-ticket items (imaging, outpatient surgery).
Prescription tiers and any prior-auth on key meds.
Out-of-pocket maximum is a number you can live with.

What drives price (non-subsidized)

The big levers

Age rating for adults; kids usually add less than another adult.
ZIP/county + network breadth.
Deductibles, coinsurance, copays, and the out-of-pocket max.

Ways to keep it efficient

Don’t overbuy—match benefits to how you actually use care.
Choose networks that include your real providers (not just brand names).
Use generics when clinically appropriate; we’ll check formulary tiers.

Who typically chooses Private PPO

Strong fit

Self-employed/1099 families who want broad doctor choice.
Frequent travelers or multi-state households.
People who dislike referral bottlenecks.

Maybe not a fit

Households whose main goal is max subsidies and the lowest possible premium.
Anyone who does not have specific providers to keep and rarely needs out-of-area care.

Want the best non-Marketplace fit in your ZIP?

We’ll verify your doctors and meds, compare PPO options, and show clear costs. No pressure—just answers.

Get Free Quotes Book a Call

FAQ

Are Private PPOs the same as Marketplace plans?

No. These are non-Marketplace plans available via licensed-agent access. Pricing isn’t tied to ACA tax credits.

Do Private PPOs need referrals?

Typically no—one of the big reasons people switch. We’ll confirm rules for your exact network.

Will I owe taxes if I’m not using subsidies?

Private PPOs don’t use ACA credits, so there’s no subsidy reconciliation. On the Marketplace, credits reconcile—if income is higher than estimated, payback can apply. Ask your tax pro for details.

How do I know if my doctor is covered?

Send your provider list. We check contracts and book of business, not just “find-a-doc” directories.

How do we start?

Share your doctors, prescriptions, and budget. We’ll map your options and enroll you quickly and compliantly.

This overview is educational, not tax or legal advice. Plan availability and rules vary by state and carrier. Eligibility and enrollment subject to underwriting/plan terms where applicable.

Robert Adams 8/28/25 Robert Adams 8/28/25

New to Florida? Health Insurance—Fast Guide (Marketplace vs Private PPO)

Fast guide for Floridians who just moved—how coverage works, proof to have ready, and how to keep your doctors. We compare Marketplace vs Private PPO and show clear costs.

New to Florida? Health Insurance—Fast Guide (Marketplace vs Private PPO)

Just moved to FL? Here’s how coverage works, what proof you’ll need, and how to keep your doctors. We’ll verify providers and show clear costs—no pressure.

Marketplace (Government)

Can be cheapest if your income qualifies for credits.
Many plans are HMO/EPO; referrals are common.
County-based options; networks vary by ZIP.
Move = special enrollment (time-limited). Credits reconcile at tax time.

Private PPO (Licensed Access)

Nationwide PPO access when eligible; keep key doctors/hospitals.
Typically no referrals; fewer hoops for specialists.
Pricing isn’t tied to ACA income credits.
Good for travel, provider choice, and specialist access.

We run both paths side-by-side with your doctors and prescriptions, so you pick based on fit—not guesswork.

What to do first (takes 5 minutes)

1) Gather quick proof

New FL address (lease, closing docs, utility, USPS change).
Prior coverage details if switching.

2) List providers & meds

Doctors, specialists, hospitals you want to keep.
Current prescriptions (name + dosage).

3) Decide priorities

Lowest premium vs. broad network.
Referrals OK or prefer no referrals?
Travel out of state?

What drives cost in Florida

Marketplace

Income & household size (for tax credits).
Plan level & network (HMO/EPO common).
County—options can change across county lines.

Private PPO

Age, ZIP, benefit level, and network size.
No ACA credits; premiums are straightforward.
Great when keeping providers is the priority.

Simple decision guide

Choose Marketplace if…

Your income qualifies for strong credits.
You’re OK with HMO/EPO rules & referrals.
Lowest premium is the top priority.

Choose Private PPO if…

You want broad, often nationwide PPO access.
You prefer no referrals to see specialists.
Keeping specific doctors/hospitals matters most.

New to Florida? Let’s lock the best fit in your ZIP.

We’ll verify your doctors and meds, compare Marketplace vs Private PPO, and show clear costs. No pressure—just answers.

Get Free Quotes Book a Call

FAQ for recent Florida moves

Do I get a special enrollment window when I move to Florida?

Yes—moves generally create a time-limited window to enroll. We’ll confirm timing and options for your county and situation.

What proof of my move do I need?

Usually a new Florida address document (lease/closing/utility/USPS change). We’ll tell you exactly what’s accepted before you apply.

When will coverage start?

Start dates depend on when you enroll and which route you choose. We’ll show the earliest eligible effective date and time the switch so there’s no gap.

Can I keep my current doctors?

Often, yes. We check your doctors against the exact plan network you choose—before you enroll—so there are no surprises.

What if I’m coming from COBRA?

You can stay on COBRA or switch to Marketplace/Private PPO. We’ll compare costs and timing so you only pay for what you need.

This overview is educational, not tax or legal advice. Availability and rules vary by carrier and county. Eligibility and enrollment subject to plan terms.

Robert Adams 8/25/25 Robert Adams 8/25/25

Marketplace vs Private PPO: Costs, Networks, and When Each Wins

Fast guide to non-Marketplace Private PPOs—how they bill, who they fit, and what to verify first. We’ll confirm your doctors, compare options, and show clear costs

You want the truth without the fluff. Here it is: Marketplace (Government) can be cheapest when your income qualifies for savings. Private PPO (licensed-access) usually wins on keeping doctors, network size, and fewer hoops. We run both—then you choose.

Quick definitions

Marketplace (Government): Plans on Healthcare.gov or your state exchange. The monthly cost can drop with income-based savings. Networks tend to be HMO/EPO-heavy in many areas.
Private PPO (licensed-access): Off-exchange, available through licensed agents. Typically, broader PPO networks, out-of-network flexibility, and year-round availability.

👉 No guessing: We verify your doctors and prescriptions on both sides before you enroll.

Cost snapshot (realistic)

Marketplace: Price depends on income and household. Silver plans can unlock additional savings if you qualify.
Private PPO: Price isn’t income-based. You’re paying for network flexibility and smoother access.

Network & doctors (what actually matters)

Marketplace networks can be narrow. Great if your providers are in-network; painful if not.
Private PPOs typically offer national or near-national networks, along with out-of-network benefits .
We check your providers first—not after you enroll.

When Marketplace wins

Your income qualifies for strong savings.
You’re fine with a narrower network and staying in-network.
You want the lowest possible premium and rarely use care.

When Private PPO wins

You want flexibility with doctors and facilities
You want PPO flexibility for frequent travel
You’ve been burned by referrals/authorizations, and now you want fewer hoops.

The simple decision tree

Share your providers, prescriptions, and budget.
We verify both paths (Marketplace vs Private PPO) in your ZIP.
You pick the best fit. We enroll you quickly and compliantly.

Get Free Quotes Book a Call

Robert Adams 8/19/25 Robert Adams 8/19/25

Trump’s “Big, Beautiful Bill” & Healthcare in 2025: Florida Private PPO vs ACA

Trump’s “Big, Beautiful Bill” could reshape health insurance in 2025. Learn how Florida families, self-employed professionals, and small business owners are weighing private PPO plans with $0 deductibles as alternatives to ACA subsidies and government-backed options.

Trump’s latest legislation — the One Big Beautiful Bill Act — is shaking up healthcare in 2025.

Passed on July 4, 2025, the sweeping budget and tax package slashes Medicaid funding, phases out subsidies for ACA marketplace plans, and adds new eligibility hurdles with work requirements.

These changes mean one thing: millions of Americans will pay more, qualify for less, and face shrinking coverage options.

👉 If you’re self-employed, uninsured, or relying on ACA/Medicaid, here’s why this matters — and why private PPO health plans with $0 deductibles and nationwide networks are quickly becoming the most reliable alternative.

What Is Trump’s “Big, Beautiful Bill”?

Trump has consistently attacked the ACA (Obamacare), calling for reforms that expand private market choice and reduce government subsidies. His campaign references a sweeping replacement plan — nicknamed the “Big, Beautiful Bill” — which is expected to:

Cut down on federal subsidies for ACA marketplace plans
Expand short-term and alternative private plans
Shift more power back to states on Medicaid expansion
Increase flexibility for insurers to design new PPO options

How This Could Affect Florida Families & Self-Employed Workers

Florida has one of the highest ACA enrollment rates in the country. More than 4 million residents currently use ACA marketplace coverage — with many relying on subsidies to make premiums affordable.

If Trump’s “Big, Beautiful Bill” rolls back subsidies or changes Medicaid access, here’s what it could mean:

Higher out-of-pocket costs for unsubsidized middle-class families
Fewer options for those who earn “too much” to qualify for ACA subsidies but still need affordable care
More gaps for self-employed professionals who don’t have employer coverage

That’s why a growing number of Floridians are exploring private PPO health insurance plans as an alternative.

Why Private PPO Plans Are Getting Attention

Unlike ACA marketplace plans, private PPO (Preferred Provider Organization) health insurance can provide:

$0 deductibles (vs. ACA plans that often carry $9,000–$18,000 deductibles)
Nationwide provider access — not limited to local HMO networks
Lower monthly premiums compared to unsubsidized ACA rates
Custom underwriting that can approve healthier applicants for lower costs

For small business owners, families, and 1099/self-employed workers, these plans are becoming a serious alternative — especially if ACA subsidies shrink.

ACA vs. Private PPO in 2025: Key Differences

ACA Marketplace (2025):

Deductibles: $9k–$18k typical
Networks: Mostly HMO, state-limited
Premiums: Subsidy-dependent
Pre-existing conditions: Always covered
Customization: Very limited

Private PPO (2025):

Deductibles: $0 options available
Networks: Nationwide PPO
Premiums: Often lower than unsubsidized
Pre-existing conditions: Case-by-case underwriting
Customization: Flexible

👉 For many Floridians who don’t qualify for subsidies, PPO plans are the most affordable path forward.

What About COBRA & Health-Share Alternatives?

Some Americans leaving employer coverage consider COBRA or health-share ministries as a stopgap. But both have drawbacks:

COBRA: Extremely expensive (full premium + 2% admin fee)
Health-Share: Not true insurance, limited protection, and often excludes pre-existing conditions

In comparison, private PPO insurance often provides better protection at a fraction of the cost.

The Bottom Line: Be Ready for 2025 & 2026

With Trump’s “Big, Beautiful Bill” passed, the takeaway is clear:

ACA subsidies may not be as reliable moving forward
Medicaid access is shrinking, especially in states like Florida
Private PPOs are positioned to grow in popularity as ACA alternatives

What You Can Do Today

✅ Compare your ACA plan vs. private PPO quotes now

✅ See if you qualify for $0 deductible coverage

✅ Protect yourself from future premium hikes

At RKA Insurance Advisors, we specialize in helping Florida families, self-employed professionals, and small business owners find affordable PPO health coverage without the hassle of government-run plans.

👉 Get Your Free Quote Today

Robert Adams 2/21/25 Robert Adams 2/21/25

Affordable Health Insurance in Florida for the Self-Employed – 2025 Guide

Florida Self-Employed Health Insurance (2025): PPOs, ACA, HSAs & Smart Cost Moves | RKA

Florida • Self-Employed Guide

Florida Self-Employed Health Insurance (2025): Your Practical Guide

Fast take: If you’re self-employed in Florida, you can choose between ACA Marketplace plans (with potential subsidies) and private medically underwritten PPOs if eligible—plus HSA strategies that may lower taxes. The right fit depends on income, doctors, travel needs, and how you prefer to pay (premium vs. out-of-pocket).

Your main paths in 2025

1) ACA Marketplace (Obamacare)

Why it wins: Guaranteed issue, potential premium tax credits and cost-sharing reductions based on your 2025 MAGI.
Consider: Networks can be narrower; compare your doctors and Rx tiers before enrolling.
Best for: Variable income or households likely to qualify for subsidies.

2) Private Medically Underwritten PPO

Why it wins: Broad PPO access and potentially lower premiums vs. unsubsidized ACA plans for healthy applicants.
Consider: Approval is selective; eligibility depends on your health profile. We pre-screen quickly.
Best for: Frequent travelers, provider-sensitive households, and those who pass underwriting.

3) HSA-friendly plan strategy

Why it wins: Contributions may reduce taxable income; funds roll over year to year.
Consider: You’ll want a cushion for routine care; HSAs work best if you can save steadily.
Best for: Self-employed with predictable or lower annual usage who value tax efficiency.

How to choose (simple framework)

Income: If you likely qualify for subsidies → price the ACA first.
Doctors/hospitals: If specific providers matter → confirm networks (ACA vs. PPO) before anything else.
Travel: If you work around Florida/US → PPO flexibility can reduce out-of-network surprises.
Cash flow: Prefer predictable premiums? Consider richer plans or PPOs; comfortable with variability? HSA paths can win.

Quick FAQs (Florida • Self-Employed • 2025)

How do I estimate my 2025 income for subsidies?

Start with your expected net self-employment income (after allowable business expenses) and adjust for other household income. We can run scenarios if your income fluctuates month-to-month.

Can I switch from ACA to a private PPO mid-year?

Private PPOs may be available year-round if you qualify. Enrollments and effective dates vary by carrier—ask us to check timing.

Do HSAs work if I’m self-employed?

Yes, if you select an HSA-eligible plan. Contributions may be tax-deductible and can be invested; withdrawals for qualified medical expenses are tax-free.

Will you verify my providers?

Yes—send your provider list and preferred hospitals. We’ll check participation across ACA and PPO options before you choose.

For education only; benefits and eligibility vary by carrier and state. Always review official plan documents.

Robert Adams 1/28/25 Robert Adams 1/28/25

Year-Round Health Insurance Options – How to Get Covered Outside of Open Enrollment

Year-Round Health Insurance Options Outside Open Enrollment | RKA

Enrollment Guides • Year-Round Options

Year-Round Health Insurance Options Outside Open Enrollment

Fast take: Missed Open Enrollment? You still have paths. Qualify for a Special Enrollment Period (life event or some income situations), or—if eligible—apply for a private, medically underwritten PPO that can start any month. We’ll verify doctors, prescriptions, and start dates to avoid gaps.

Path #1: Special Enrollment Period (SEP)

If you’ve had a Qualifying Life Event, you can enroll in ACA Marketplace coverage outside the normal window. Common QLEs:

Loss of coverage: losing employer coverage, aging off a parent’s plan, COBRA ending.
Household changes: marriage, divorce, birth/adoption, death.
Residence changes: moving to a new ZIP/state with different plan options.
Income changes: shifts that affect subsidy eligibility (varies by state and year).

Timing: Most SEPs last 60 days from the event. We’ll help confirm your documentation and the correct effective date.

Path #2: Income-based options (some situations)

In certain circumstances, income within specific ranges can create ongoing or monthly SEP eligibility. If your income is variable, we’ll model your estimated MAGI and confirm your current-year eligibility.

Path #3: Private, medically underwritten PPO (if eligible)

Year-round starts: Many private PPOs offer effective dates any month after underwriting.
Broader networks: Often nationwide PPO access—great for frequent travelers or multi-state households.
Underwriting: Health questions apply; we pre-screen quickly and verify your doctors/hospitals.

Avoid gaps: simple checklist

List your providers (names, locations) and prescriptions.
Note your QLE date and keep documents handy.
Share your target start date so we align deadlines and carrier cutoffs.
We’ll show total annual cost (premium + likely usage) for each option.

Quick FAQs

How fast can coverage start?

Marketplace plans often begin the 1st of the next month if you enroll by the cutoff. Private PPOs can start after approval on the 1st or 15th, depending on carrier.

What if I don’t have a QLE?

We’ll explore private PPO options (if eligible) or the next Open Enrollment timeline. We’ll also check if income-based rules could open a SEP.

Can you confirm my doctors?

Yes. Send your provider list and we’ll verify participation across ACA plans and private PPO networks before you enroll.

For education only; eligibility, plan availability, and dates vary by state and carrier. Always review official Marketplace and plan documents.

Robert Adams 11/21/24 Robert Adams 11/21/24

Affordable Health Insurance in Florida for the Self-Employed – 2025-2026 Guide

Open Enrollment Health Insurance Deadlines: What to Know & When to Enroll | RKA

Guide • Open Enrollment

Open Enrollment Health Insurance Deadlines: What to Know & When to Enroll

Fast take: Open Enrollment is the main window to choose coverage for the upcoming year. If you miss it, you’ll need a Special Enrollment Period (life event or qualifying income) or you can explore eligible private PPO options if you qualify.

Key windows at a glance

Open Enrollment (most states)

Occurs in late fall through mid-January for coverage beginning Jan 1 (or Feb 1 for later selections).
Best time to compare ACA plans and confirm doctors/Rx.
We’ll confirm this year’s exact dates for your state.

Special Enrollment (life events)

Qualifying Life Events (QLEs): loss of coverage, marriage/divorce, birth/adoption, move, etc.
Typically a 60-day window (varies by event/state).
We help document and enroll before the deadline.

Income-based SEP (some situations)

Certain income ranges may unlock a monthly SEP in some states.
Helpful if income fluctuates or you missed OEP.
We’ll check eligibility and project your MAGI.

Private PPO (if eligible)

Some medically underwritten options enroll year-round.
We pre-screen underwriting and confirm nationwide access.
Useful for travelers or doctor-specific households.

How to avoid missing your window

Set reminders: Book a consult ahead of OEP so we can verify doctors and run cost projections.
Gather details: Provider list (names & locations), prescriptions, and estimated income (MAGI).
Pick confidently: We’ll show total annual cost (premium + likely usage) and confirm effective dates.

Quick FAQs

Do state-based Marketplace dates differ?

Yes, some state Marketplaces adjust start or end dates. We’ll verify your current-year window for your ZIP.

Can I switch plans mid-year?

Usually only with a Qualifying Life Event or an income-based SEP. Otherwise you’ll wait for OEP.

Are private PPOs available in my state?

Eligibility and availability vary. We’ll pre-screen quickly and confirm provider networks before you switch.

For education only; eligibility, plan availability, and dates vary by state and carrier. Always review official Marketplace notices and plan documents.

Robert Adams 10/23/24 Robert Adams 10/23/24

Open Enrollment 2026: Why Working with a Licensed Advisor is Essential

Open Enrollment 2025 is here. Don’t go it alone—licensed advisors know ACA vs. private PPO options, deadlines, and ways to save. Acting early avoids rate hikes and limited plan choices.

Open Enrollment 2025: The Hidden Costs of Doing It Alone | RKA

Enrollment Guides • Open Enrollment 2025

Open Enrollment 2025: The Hidden Costs of Doing It Alone

Fast take: Open Enrollment is your only chance each year to secure or update coverage—but going solo can cost you. Licensed advisors know deadlines, subsidies, and private PPO alternatives to help you avoid higher premiums and missed benefits.

Why working with an advisor matters

A licensed advisor not only has access to all available plans—including ACA Marketplace and private options—but also the expertise to evaluate your needs and recommend coverage tailored to your situation. Many unlicensed brokers push limited-benefit plans that don’t protect you when it matters most.

Key benefits of guidance

Accurate info on what your plan covers.
Verification of which doctors are in-network.
Projection of maximum out-of-pocket costs.
Strategies to maximize savings based on income & health.

How a licensed advisor may save you money

Private PPOs can reward good health with lower premiums—similar to car insurance rewarding safe drivers. ACA Marketplace plans offer income-based savings. By reviewing both, advisors help you avoid costly mistakes and secure the best value.

Quick steps to start enrollment with confidence

Open Enrollment runs November 1 – January 15, but acting early locks in better options:

Nov 1: Open Enrollment begins.

Robert Adams 10/4/24 Robert Adams 10/4/24

Preparing for Open Enrollment 2025: Key Steps Every Consumer Should Know

Open Enrollment is fast approaching—and missing the window could leave you uninsured or stuck with a costly plan. With new premium changes, policy options, and limited timelines, it’s critical to prepare now. In this guide, discover the key steps for preparing for open enrollment 2025, including vital dates, coverage comparison tactics, and expert tips to secure the right plan for you.

Open Enrollment 2025: Dates You Can’t Miss

Open Enrollment Begins: November 1, 2024
Open Enrollment Ends: January 15, 2025
Coverage Begins if Enrolled by December 15, 2024: January 1, 2025
Coverage Begins if Enrolled by January 15, 2025: February 1, 2025

Make sure to double-check your state’s specific timeline, as some states may have slightly different deadlines. Missing the Open Enrollment window could leave you without coverage for the year unless you qualify for a Special Enrollment Period.

Pro Tip: Set reminders on your phone or calendar for these key dates so you don’t miss out!

Federal Changes That May Affect Your Plan

Every year, federal regulations can impact your health insurance options. In 2025, several potential shifts may directly affect your premiums, subsidies, and coverage:

Premium Tax Credit Adjustments: Changes in eligibility or the amount of premium tax credits could affect how much you pay each month.
Expanded Coverage Options: Watch for updates around Medicaid expansion and subsidies for lower-income households.
Prescription Drug Pricing Reforms: Proposed federal reforms could cap or lower the cost of prescription medications, potentially impacting your out-of-pocket expenses.

Staying ahead of these changes is crucial to ensure you’re making the best choices for your health and financial well-being.

How to Compare Marketplace and PPO Options This Year

It’s no secret that healthcare costs continue to rise, and premiums are expected to increase by 5% to 10% in 2025. These increases could hit plans with broader networks or more comprehensive coverage harder. But there are steps you can take to mitigate the impact:

Review your rates as soon as they are released.
Consider adjusting your plan to better fit your current healthcare needs and budget.
Look for plans that offer additional benefits like telehealth, which could help offset higher premiums.

Compare Your Plan Options Thoroughly

Even if you’re happy with your current plan, reviewing other options during Open Enrollment is a smart move. Plans change year to year, and what worked for you in 2024 might not be the best fit for 2025.

Ask yourself:

Has my family’s healthcare usage changed?
Do I expect any major medical treatments or procedures?
How well did my current plan cover prescriptions, preventive care, and doctor visits?

Where to Compare Plans:

HealthCare.gov: Use the federal marketplace’s tools to compare plans side by side.
State Marketplaces: Some states offer their own marketplaces with unique options.
Licensed Agents: Consulting a licensed agent is one of the best ways to navigate the complexities of health insurance. Their expertise can help you make sense of new plans, rate increases, and potential federal changes.

Get Professional Help from Licensed Experts

Navigating the complexities of health insurance can be overwhelming, especially with the annual changes. That’s where RKA Insurance Advisors comes in. Our team of licensed agents is here to help you:

Break down your current plan and compare it to new options.
Understand how federal changes could impact you.
Advocate on your behalf if issues arise with claims, billing, or coverage.

Our agents are experts in both marketplace and private plans, ensuring that you get the right coverage for your needs at the most affordable rate possible. With thousands of satisfied clients, our track record speaks for itself.

Here’s what some of our clients have to say:

"I was so overwhelmed with all the choices, but my licensed agent broke everything down so clearly. I feel confident I have the right coverage going into next year." — Sarah T., mother of three

"After years of overpaying, I finally feel like I have a plan that works for my family. I couldn’t have done it without the help of a professional." — John M., small business owner

Don’t Wait—Act Now!

With so much at stake, don’t leave your health insurance to the last minute. Start early, compare your options, and consult with a licensed professional. The health insurance landscape is complex, and having expert guidance can ensure you make the best choices for yourself and your family.

Why Trust RKA Insurance Advisors?
With over a decade of experience, we’ve helped thousands of individuals, families, and businesses secure the right health insurance coverage. Our licensed agents are highly trained, certified, and committed to giving you the best experience possible. We are licensed in 32 states and offer a wide variety of plans tailored to your needs.

Your Next Step:

Don’t navigate Open Enrollment alone. Click HERE to schedule a free consultation with one of our licensed agents, or call us directly at 561-806-9913. We’re here to answer your questions, help you explore your options, and ensure you have the coverage you need for 2025.

Secure your peace of mind—contact RKA Insurance Advisors today.

www.RKAInsuranceAdvisors.com

Info@RKAInsuranceAdvisors.com

561-806-9913

Robert Adams 7/25/24 Robert Adams 7/25/24

Understanding Insurance Networks: A Key Component of Your Health Coverage

HMO, PPO, EPO, POS—your plan’s network determines which doctors you can see and what you’ll pay. Learn the key differences, when referrals apply, how out-of-network care works, and which network type best fits your doctors, prescriptions, and travel needs.

Understanding Health Insurance Networks: HMO vs PPO vs EPO vs POS | RKA

Guide • Networks & Access

Understanding Health Insurance Networks: HMO vs PPO vs EPO vs POS

Fast take: Your network determines where you can get care and what you’ll pay. If you have must-keep doctors, travel frequently, or want nationwide access, choose your network type first—then compare deductibles and copays.

The four common network types

HMO — “Stay in the circle”

Primary Care Physician (PCP) and referrals usually required.
No out-of-network coverage (except emergencies).
Often lower premiums; tight local networks.

PPO — “More flexibility”

No referrals needed to see specialists.
Out-of-network benefits (higher costs); national networks vary.
Good for travelers or multi-state families.

EPO — “HMO-like, no referrals”

Referrals typically not required.
Little to no out-of-network coverage beyond emergencies.
Popular on ACA Marketplace; check local access.

POS — “Hybrid”

PCP + referrals for in-network care.
Some out-of-network benefits at higher cost.
Useful when you want a PCP gatekeeper with flexibility.

Key rules to check before you enroll

Provider verification: Search by doctor name + NPI and confirm at the practice level.
Facility alignment: A doctor can be in network while their preferred hospital is not—verify both.
Prior authorization: Imaging, infusions, surgeries, and some meds may need pre-approval.
Rx formulary & tiers: Confirm your drugs, quantity limits, and preferred pharmacies.
Out-of-area care: If you travel or have college students away from home, read the away-from-home rules.

Which network should I choose?

Keep local doctors, low cost: HMO/EPO may work—verify providers and prior-auth rules.
Travel frequently / multi-state family: PPO or a plan with nationwide access is usually safer.
Want a coordinating PCP but some flexibility: POS can balance referrals with out-of-network options.

Quick FAQs

Are urgent care visits covered out of network?

Depends on the plan. Many HMOs/EPOs limit coverage to emergencies outside the service area. PPOs usually cover out-of-network urgent care at higher cost.

My doctor says they “take” my plan—am I safe?

Always verify with the plan’s directory and the office billing team. “We take it” can mean they’ll file a claim, not that they’re in network.

Can I change networks mid-year?

ACA plans generally change during Open Enrollment or with a qualifying life event. Some private options may allow year-round enrollment if eligible.

For education only; benefits and eligibility vary by carrier and state. Always review official plan documents.

Robert Adams 5/26/24 Robert Adams 5/26/24

How Biden’s 2025 Short-Term Insurance Rule Changes Affect You

Biden’s new short-term insurance rule cuts plans to 3 months with only a 1-month renewal. Self-employed workers and contractors may be at risk—see ACA, PPO, and employer coverage alternatives with RKA.

What Changed in Biden’s Short-Term Insurance Rule? | RKA

Health Insurance Updates • Policy Change

What Changed in Biden’s Short-Term Insurance Rule?

Fast take: Starting in September 2025, new federal rules limit short-term medical plans to 3 months, with just a 1-month renewal. This change reduces flexibility and leaves many—especially self-employed workers—needing new solutions.

Why the new rules put many at risk

Providers like Golden Rule, National General, Everest, and Pivot Health have offered short-term plans as flexible, stopgap coverage. Under the new rule, these plans are much less viable. Many households will need to reassess coverage options before losing protection.

Your alternatives: Marketplace vs. underwritten plans

ACA Marketplace Plans

These plans guarantee acceptance regardless of pre-existing conditions. Subsidies may reduce premiums, but networks and deductibles can vary widely.

Medically Underwritten Plans

For healthy individuals, private PPOs may provide lower monthly costs and nationwide access. Underwriting applies, but these plans often mean lower out-of-pocket exposure compared to unsubsidized ACA coverage.

Employer Coverage

If you’re eligible through an employer, group plans remain strong options. However, adding dependents can drive up costs—so review carefully.

Secure your coverage today

The new rules significantly reduce the flexibility of short-term plans. Acting now ensures you avoid gaps in coverage and rising costs. At RKA Insurance Advisors, we specialize in navigating these changes and finding the right coverage in 32 states.

Quick FAQs

When does the new rule take effect?

It begins in September 2025, limiting short-term plans to 3 months with just 1 renewal month.

Can short-term plans still be useful?

Yes, but only as very temporary stopgap coverage. For most, a Marketplace or private PPO plan will be better long-term.

How can RKA help?

We’ll verify your doctors, compare plan types, and recommend the best option tailored to your needs before the rules take effect.

For education only; eligibility, availability, and pricing vary by carrier and state. Always review official plan documents.

Robert Adams 4/17/24 Robert Adams 4/17/24

Understanding Health Insurance Networks: PPO vs. HMO for Small Businesses

PPO vs. HMO for small businesses: referrals, out-of-network rules, costs, and network fit. Learn how a licensed advisor can design the right coverage for your employees and budget.

Understanding Health Insurance Networks: PPO vs. HMO for Small Businesses | RKA

Small Business • Networks & Access

Understanding Health Insurance Networks: PPO vs. HMO for Small Businesses

Fast take: Picking the right network type can save your company money and headaches. PPOs emphasize flexibility and out-of-network benefits; HMOs emphasize lower premiums and coordinated in-network care. We’ll help you match the network to your people, locations, and providers.

What is an insurance network—and why it matters

Networks determine where employees can get care and what they’ll pay. Choosing between a PPO (Preferred Provider Organization) and an HMO (Health Maintenance Organization) affects specialist access, referrals, travel coverage, and out-of-network costs.

PPO — flexibility & broader access

No referrals required to see specialists.
Out-of-network coverage available (higher cost-share).
Often better for multi-state or traveling teams.
The insurer typically does not dictate treatment via gatekeeping.

HMO — tight networks & coordinated care

Primary Care Physician (PCP) required; referrals common.
Generally no out-of-network coverage (emergencies excepted).
Often lower premiums with strong in-network coordination.
The plan may have more say in course of care via approvals.

PPO vs. HMO: cost, flexibility, and coverage

Costs: HMOs can look cheaper monthly, but PPOs may avoid expensive out-of-network surprises for certain providers or travel patterns.
Access: PPOs allow direct specialist access; HMOs typically require PCP referrals.
Network fit: Always verify doctors + facilities; a doctor may be in network while their hospital is not.

Why a licensed advisor makes a difference

Expert guidance: Understand fine print on referrals, prior auth, and tiered networks.
Customized designs: Plan mixes (HMO + PPO), contribution strategies, HSA compatibility.
Compliance assurance: Avoid penalties and stay aligned with regulations.
Real savings: Prevent gaps and capture cost-savings your team will actually feel.

Risks of going it alone

Incomplete coverage: Overlooking network or facility alignment can create costly surprises.
Compliance issues: Missteps can trigger penalties or employee complaints.
Missed savings: Without modeling total annual cost, you can overpay for the wrong network.

Quick FAQs

Is a PPO always the safer choice?

Not always. If your team’s care is local and in-network, an HMO can be cost-effective. If people travel or need specific specialists, a PPO may avoid hassles and surprise bills.

Do HMOs ever cover out-of-network care?

Typically only emergencies. Read your plan’s rules for away-from-home care and urgent care coverage.

How do we verify our doctors?

We check by clinician and facility (NPI/location) across carriers, then document acceptance and likely costs before you choose.

For education only; benefits and eligibility vary by carrier and state. Always review official plan documents.

Robert Adams 3/20/24 Robert Adams 3/20/24

Avoid Tax Penalties: Navigating Health-Insurance Income Reporting (2025–2026) | RKA

Taking ACA premium credits? Keep your income estimate current and reconcile correctly to avoid surprise tax bills. Here’s how MAGI works, when to update, and how RKA helps.

Avoid Tax Penalties: Navigating Health-Insurance Income Reporting (2025–2026) | RKA

Guides • Taxes & Reporting

Avoid Tax Penalties: Navigating Health-Insurance Income Reporting

Fast take: If you get ACA premium tax credits, your final subsidy is based on your actual year-end income (MAGI). To avoid surprise tax bills, keep estimates current, report life changes quickly, and reconcile correctly at tax time.

MAGI 101: What actually counts

Start with AGI (from your 1040), then adjust for items like tax-exempt interest and nontaxable Social Security.
Household MAGI includes the income of everyone on the return who must file taxes, not just the policyholder.
Self-employed? Use net profit (after allowable business expenses), and revisit as the year unfolds.

Update income at the right times

After big changes: new contract, raise/bonus, switching jobs, adding/removing a dependent, or moving.
Quarterly check-ins: especially for variable/1099 income—prevents large year-end paybacks.
Document it: keep notes on when/why you updated; it helps at tax time.

A simple, low-stress workflow

Estimate annual MAGI (with a conservative range).
Choose a plan; take only the advance credit you’re comfortable with.
Track YTD income and adjust through your Marketplace account when needed.
At tax time, reconcile with Form 1095-A and Form 8962.

Self-employed tips

Buffer fund: set aside part of any premium savings for potential reconciliation.
HSA strategy: if you’re in an HSA-eligible plan, contributions may lower MAGI.
Quarterly rhythm: align income updates with your estimated tax payments.

Quick FAQs

What if I overestimated income?

You may receive an additional refund when you reconcile. Keeping estimates realistic helps avoid large swings.

Do I need to report small fluctuations?

If your YTD trend suggests your annual MAGI will change meaningfully, yes—update it. Small, temporary swings usually don’t require action.

Can you update my application for me?

Yes—RKA can walk you through changes or assist directly so your plan and credits stay aligned.

This article is educational and not tax advice. Eligibility and benefits vary by carrier and state. Consult your tax professional about your specific situation.

Robert Adams 2/29/24 Robert Adams 2/29/24

Traveler-Friendly Health Insurance: Stay Covered Wherever You Go

Traveler-friendly health insurance with nationwide PPO access. Get urgent care & ER coverage on the road. Compare options & enroll fast with RKA.

Traveler‑Friendly Health Insurance: Stay Covered Wherever You Go | RKA Insurance Advisors

Travel Health Coverage

Traveler‑Friendly Health Insurance: Stay Covered Wherever You Go

Updated Aug 28, 2025 • Originally published Feb 29, 2025 • By Robert Adams

On this page: Why traveler‑friendly plans • Key features • How RKA helps • FAQs

Whether you’re on the road for work, chasing weekend getaways, or planning a cross‑country move, having reliable coverage that travels with you matters. Traveler‑friendly plans—often built on nationwide PPO networks—help you access urgent care, ERs, and a broad set of in‑network doctors across the U.S.

Tip: Before you go, add your plan ID card to your phone wallet and bookmark your carrier’s provider search. If you’re unsure about a facility, text or call us and we’ll verify network status for you.

Why traveler‑friendly health insurance?

If you spend time outside your home area, a PPO gives you flexibility without referrals and, on many plans, nationwide in‑network access. That can mean lower bills and faster check‑in when you need care away from home.

Key features frequent travelers value

1) Nationwide provider access

Tap into large, national networks so you can see in‑network providers in most cities and states, from urgent care to specialists.

2) Emergency & urgent care coverage on the road

Emergencies don’t wait. With the right plan, ER and urgent care visits while traveling are covered per your policy terms, with predictable cost sharing.

3) Help coordinating care

We’ll confirm network participation, estimate costs, and schedule appointments for you—so you focus on the trip, not the paperwork.

4) Options for international travel

Going abroad? Pair your domestic plan with short‑term travel medical for overseas emergencies and evacuation benefits.

How RKA Insurance Advisors helps

Plan matching: We compare traveler‑friendly PPO options across carriers in the 30+ states where we’re licensed.
Concierge verification: Message us a clinic name, and we’ll check network status and expected costs before you go.
Fast enrollment: Same‑day enrollments available in many cases; options exist year‑round depending on your situation.

Get Quotes Now Book an Appointment

Want proof you’re in good hands? See our Google reviews and learn about our services.

Traveler FAQs

Does PPO health insurance cover me while traveling out of state?

Yes. With a PPO network, members typically have nationwide access to participating providers for urgent care, ERs, and many outpatient services. Benefits depend on the plan; verify provider participation and any out‑of‑network cost sharing before you go.

Do I need separate travel medical insurance for international trips?

U.S. plans often have limited or no coverage abroad. For international travel, a short‑term travel medical policy can cover emergencies and evacuation. We’ll help you compare options.

What’s better for travelers: PPO or HMO?

PPOs offer broader, often nationwide networks and don’t usually require referrals—ideal for frequent travelers. HMOs tend to be regional and referral‑based; out‑of‑area care is typically emergency‑only.

How do I check if a provider is in‑network while traveling?

Use the carrier’s provider lookup or call member services. Or text/call us—we’ll verify and estimate costs.

Can I get short‑term coverage just for a trip?

Yes—short‑term medical or travel medical may fit. We’ll review dates, destinations, and needs to recommend the right fit.

Robert Adams 2/9/24 Robert Adams 2/9/24

Year-Round Health Insurance Options: Finding Coverage Anytime, Anywhere

Health insurance is vital to financial security and well-being, providing essential coverage for medical expenses when you need it most. While many people are familiar with the annual open enrollment period for health insurance, it's important to know that options are available year-round to ensure you have coverage whenever you need it.

Understanding Year-Round Health Insurance Options:

Year-round health insurance options are available outside of the traditional open enrollment period, providing individuals and families with the flexibility to obtain coverage anytime. These options include:

ACA-Compliant Plans: Certain qualifying life events, such as marriage, birth or adoption of a child, loss of other health coverage, or relocation to a new state, may trigger a special enrollment period that allows individuals to enroll in ACA-compliant health insurance plans outside of the regular open enrollment period.
Medicaid and CHIP: Medicaid and the Children's Health Insurance Program (CHIP) provide low-cost or free health coverage to eligible individuals and families with limited income and resources. Enrollment in these programs is available year-round, providing essential coverage to those in need.
Medically Underwritten Health Coverage: Medically underwritten health coverage takes into account your individual health status when determining eligibility and rates. If you're healthy, you may be eligible for better coverage and better rates, especially when paired with a national PPO network that offers a wide range of healthcare providers.
Short-Term Health Insurance: Short-term health insurance plans offer temporary coverage for individuals and families. These plans typically last from a few months to a year and provide limited coverage.

Benefits of Year-Round Health Insurance:

Continuous Coverage: Year-round health insurance options ensure that you have continuous coverage, protecting you and your family from unexpected medical expenses throughout the year.
Flexibility: Whether you've missed the open enrollment period or experienced a qualifying life event, year-round health insurance options offer the flexibility to obtain coverage when needed without waiting for the next enrollment period.
Peace of Mind: Having year-round health insurance coverage provides peace of mind, knowing that you're protected against unforeseen medical emergencies and can access essential healthcare services without worrying about gaps in coverage.

Why Choose Year-Round Health Insurance from RKA Insurance Advisors? At RKA Insurance Advisors, we understand that life doesn't always adhere to a strict enrollment schedule. That's why we're committed to helping individuals and families find year-round health insurance options that meet their unique needs and circumstances.

Our team of licensed insurance professionals is here to guide you through the process of finding the right coverage, whether you're looking for short-term insurance, ACA-compliant plans, medically underwritten coverage, or info on Medicaid and CHIP enrollment. With our personalized approach and expertise in the health insurance market, we'll help you secure the coverage you need when you need it most.

Don't wait for the next open enrollment period to secure the health insurance coverage you need. With year-round health insurance options available, you can find coverage anytime, anywhere, ensuring that you and your family are protected against unexpected medical expenses. Contact us today to learn more and take the first step towards comprehensive healthcare coverage.

Ready to explore year-round health insurance options tailored to your needs? Contact RKA Insurance Advisors today for personalized assistance and find the perfect coverage for you and your loved ones.

561-806-9913

Info@RKAInsuranceAdvisors.com