DEADLINE: SATURDAY, JANUARY 15TH

Jan 15th marks the final day to enroll on the marketplace for health coverage. If you haven’t secured coverage for 2022. I would advise doing so today. Not waiting till the last day to do so and of course preventing any potential issues that can occur with enrollment which would make you miss the deadline. 

The marketplace isn’t the only option available for coverage, and it may not be the best option for you. It is for an overwhelming amount of individuals who for example do qualify for subsidies due to income and or have pre-existing conditions and cannot qualify elsewhere. If that is the case you need to act now and secure your coverage for 2022. If not, you do run the risk of not being covered for the year. 

Alternatively, private PPO options are available throughout the year. Although they are not for everyone, as you do need to be approved based upon medical history. Not everyone is eligible for this type of coverage. Of course, if you have a qualifying life event, such as change of primary address, loss of coverage, or change of household size being some of the qualifying events, that can open you up to a special enrollment period on the marketplace. 

If you are uninsured, reach out today and secure coverage before it’s too late. Our team of licensed specialists will go over all your available coverage options to help you determine which plan best meets your needs. Even if you do have coverage, via employer, marketplace, or private. Reach out to make sure you are in the best position with being protected before the 15th. 

Inflation and why health coverage is more important than ever

When we think of inflation as we are currently seeing the highest levels in 30 years. We typically think of day-to-day expenses, food, goods, electricity, gas, etc. What we don’t think of is inflation as it pertains to our medical costs. Yes, that’s right our medical cost. For the last decade, health care prices have consistently grown at roughly a rate of 1 percent to 2 percent. Already, in the last 18 months, prices for hospital and physician prices have exceeded a 3 percent inflation rate. Although the percentage of increase is less than other sectors and consumer products. The same problems driving up prices in the rest of the economy — rising costs within the supply chain, difficulty finding workers for open jobs — are issues in the health care sector too. The workforce crisis in particular is acute and not likely to go away any time soon, given how many nurses and doctors have left their jobs during the pandemic. As a result of these things, it is now more important to make sure you have quality health coverage. Not only quality health coverage but make sure you speak to a licensed agent prior to making a decision when it comes to coverage & not just picking the first plan you see or the most affordable option. Decisions like that can leave you vulnerable to a lot of out-of-pocket exposure. More now than in recent years as a continual rise in healthcare costs. With rising medical costs, the uncertainty of the pandemic, shortages of other goods, having quality health coverage is more important than it has ever been. Reach out today & speak to a licensed agent to discuss your situation, needs, and options. 

Extended Open Enrollment Information

December 16, 2024 | By Robert Adams

Extended Open Enrollment: Don't Miss the January 15th Deadline

Good news! You still have time to get health insurance for 2026. Open Enrollment has been extended through January 15, 2026, giving you 30 extra days to compare plans and enroll with confidence.

⚠️ Important: If you missed the December 15th deadline for January 1st coverage, you can still enroll by January 15th for coverage starting February 1, 2026.

Key Enrollment Dates

The federal Open Enrollment period for 2026 began November 1, 2025 and closes January 15, 2026. This extended timeline gives you more time to:

• Compare Marketplace and Private PPO plan options
• Verify your doctors and prescriptions are covered
• Calculate your subsidy eligibility
• Enroll with a licensed advisor at no cost to you

What's Available for 2026?

There are several health coverage options available during Open Enrollment:

• Marketplace Plans (Healthcare.gov): ACA-compliant plans with potential income-based subsidies
• Private PPO Plans: Off-exchange underwritten options with broader networks, available only through licensed agents
• Ancillary Coverage: Vision, dental, accident, critical illness, and short-term disability

Why Work With a Licensed Advisor?

Health coverage is too important to navigate alone. Working with a licensed health insurance advisor ensures you:

• See all available options — both on and off the marketplace
• Get accurate subsidy calculations based on your income
• Have your doctors and prescriptions verified before enrollment
• Receive year-round support for claims, renewals, and coverage changes

Best of all, there's no cost to you. Licensed agents are compensated by insurance carriers, not by clients.

Ready to Compare Your Options?

Don't wait until the last day — get your free quote today

Get Free Quotes Book a Call

What Happens After January 15th?

After Open Enrollment closes, you'll need a Qualifying Life Event to enroll in Marketplace plans. Common qualifying events include:

• Loss of employer-sponsored coverage
• Marriage or divorce
• Birth or adoption of a child
• Permanent move to a new state or county
• Loss of Medicaid or CHIP coverage

Important note: Private PPO plans may be available year-round depending on your health status and location. Contact us to explore your options even after the Open Enrollment deadline.

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Need help before the deadline? Call us at 561-806-9913 or get your free quote online. We're licensed in 32 states and ready to help you find the right coverage.

Changes to 2022 Open Enrollment

With 2022 open enrollment quickly approaching, a lot of individuals are up for renewals on their current health plans or now have an opportunity to seek coverage. There has been a lot of major changes to this year’s enrollment period and we will list that information for you here. The first thing is, when is the open enrollment period and when does it end?

• Nov 1st - Jan 15th

• Enrollment before Dec 15th coverage starts Jan 1st

• Enrollment between Dec 16th and Jan 15th coverage will start Feb 1st

This gives individuals an extra month to get health coverage in place for the year, 30 extra days to shop for a plan that meets their needs and budget. Speaking of budgets, this year there will be increased subsidies offered on the marketplace as well. To qualify for a subsidy, your household income must be below 138% of the federal poverty level of $26,500 to qualify. To qualify for a premium tax credit, your household income must be between 100% and 400% of the federal poverty level. Great news for a lot of people. However, if you do not qualify, or are not satisfied with the plans on the marketplace you are not limited to just securing coverage on the marketplace. I always advise speaking to a benefits specialist to determine which plan is best for you.

For 2022 health coverage, the Max out of pocket limit is $8,700 for a single person and $17,400 for a family. This applies to in-network care for essential health benefits. This is the most an insurer is allowed to offer regarding max out of pockets. Now, not all plans will have such high max out of pockets, and there are plans outside the marketplace that do offer lower out-of-pocket exposure as well.

With all the changes this year, it has made it attractive for a lot of major carriers who left the marketplace to return, most notably is United HealthCare, Expanding a massive footprint nationally for individuals who can now obtain their plans on the marketplace. Carriers such as CVS/Aetna have returned to the marketplace as well. Anthem has increased its presence in multiple states along with Avmed. This is great news as some of the largest insurance carriers now offering coverage on the marketplace exchange.

Some other notable changes for 2022 is an involuntary loss of coverage is a qualifying life event that allows a person to enroll in an individual/family plan outside of the annual open enrollment period and receive a subsidy. This is great news as if you lose your job any time of the year this will allow them to take advantage of the ACA’s premium tax credits if they’re eligible, rather than having to pay full price to keep their COBRA coverage in place.

Individuals and families with household income under 150 percent of the poverty line are eligible for a monthly SEP if their premiums would be $0 after applying for tax credits. This will be the case in 2022 when the ARP enhanced tax credits reduce premiums to $0 for those in this income group. This SEP is only available through the marketplaces.

Each year, rules and regulations covering the Affordable Care Act and health insurance marketplaces/exchanges are updated. The process to do this update for 2022 was complex but resulted in several favorable changes for consumers or rolled back proposed changes that would have negatively impacted consumers. With the multiple changes to this year’s enrollment, it’s very important to make sure you speak to a state-licensed benefit specialist that can help you navigate the marketplace and all other options, in addition to answering any questions you may have. Understanding things such as what type of network you are in, what a deductible is, what is max out of pocket, are imperative to understand before choosing your health plan for the year. Reach out today to window shop the available 2022 plans.

Open Enrollment 2022: What you need to know

Open Enrollment is the period of time each year when you can sign up for health insurance or change your current coverage. Open enrollment for 2022 plans begins Monday, Nov 1st, and continues through Jan 15th, 2022 for individual and family plans.

• Enroll before Dec 15th: Coverage will start Jan 1st, 2022

• Enroll between Dec 16th and Jan 15th: Coverage will start Feb 1 2022

In some states, the Enrollment period may be different due to state policy. Check with one of our benefit specialists to see when your enrollment period is for your state.

Marketplace Plan Options

Metal Tier plans:

Bronze: Cheapest monthly cost but generally have higher deductibles and few cost-sharing benefits. (Much more out-of-pocket expenses).

Silver: Middle-of-the-road plan that balances coverage & cost.

Gold: Most expensive coverage options, has strong cost-sharing benefits lower deductibles & out of pocket exposure.

Platinum: Extremely rare coverage only available in a few counties, most expensive monthly premiums but has lowest deductibles and high cost-sharing benefits.

Networks: Most options are going to be in HMO or EPO networks Which are limited to the service area and only provide coverage outside of that for emergencies. PPO networks are only available in select counties in select states but have nationwide coverage and access to providers.

The Average cost for coverage in 2021 is $313 to $709 per month, depending on coverage level, and in 2022, most states will see an increase in the cost of health insurance. Insurers have submitted requests for their proposed rate changes, but actual rate changes must be approved by each state. Those with low to moderate incomes will pay a discounted rate for health insurance purchased through the marketplace because of Health insurance tax credits (sometimes called subsidies).

For example, a Bronze plan costs an average of $30 per month for someone who earns $30,000, and the average cost is $214 for someone who earns $45,000.

In 2022, these health insurance discounts from the Advance Premium Tax Credit (APTC) are available for those who earn between 100% and 400% of the federal poverty level. For an individual, that's an income of $12,880 to $51,520, and for a family of four, it's $26,500 to $106,000. Those who earn more than this may still qualify for discounted insurance through the marketplace based on the ratio of health insurance costs to income.

The marketplace isn’t the only option for health coverage. Each individual and or family is different & has different needs. determining factors of which plan best suits you will be income, health, lifestyle, and employment. Below are the different types of options outside of marketplace plans.

Private Medically Underwritten: Plans that offer typically lower out-of-pocket costs and lower deductibles than the marketplace if no subsidies are avilable. Select risk pool, meaning individuals need to be relatively healthy and have to go through medical underwriting for approval of coverage. Some options are guaranteed renewable till age 65 in nationwide PPO networks.

Healthshare plans: Organizations whose members “share” medical costs. As part of a health care sharing plan, you are responsible for paying in a certain share amount each month (like a premium) as well as an “annual unshared amount” for your own expenses.

Short Term Medical: Typically the most affordable option. Short-term insurance is health coverage typically available for periods from 30 days to 90 days. In some instances with some insurers, short-term medical is available for up to 12 months. But, short-term plans usually offer more limited coverage than major medical.

Fixed Indemnity: Fixed indemnity health insurance is supplemental health insurance that helps manage out-of-pocket costs. These plans provide an extra layer of protection in the event of serious injury or illness by paying you a set amount of cash benefits to cover specific medical expenses.

It’s important to always speak to a benefits specialist prior to selecting and or renewing your coverage for the year to determine which plan suits your needs and of course to make sure you aren’t overpaying for coverage. Dont make the assumption that the coverage you have is the best for you without seeing other options or speaking to a benefits specialist.

Understanding Health Coverage

With Open Enrollment starting on Nov 1st this year, it’s time for us to discuss some of the different coverage options and what to look for. The most important thing is understanding your options, what is good for you and your family might not be for the next person. A lot of factors going into finding the “right plan”, income, health, lifestyle, and even employment. The ACA made it law to cover all pre-existing conditions on the federal marketplace exchange. In addition, depending on your income, subsidies are available for individuals who can qualify based upon their household income, which is great news! Most options on the marketplace these days, with the exception of a couple of states, are HMO plans which only provide coverage in your direct service area & only cover for emergencies outside of the service area. Certain lifestyles and employment whereas you travel frequently or have children in college in different states, more than likely, it’s best to seek a nationwide PPO option which is typically found on the private market. The marketplace isn’t the only option for coverage, there are private underwritten options that are guaranteed renewable plans until 65, there are short-term options, healthshare plans, catastrophic plans. Understing your situation will help a licensed agent narrow down the options that are best for you.

Some of the other factors when choosing a health plan is what is my out-of-pocket exposure. Most people typically “price shop”, they look for the cheapest plan. Which for some people might be appropriate, paying 25 or 50/month for coverage sounds great! Having a deductible of over 8k in a restricted HMO network with a coinsurance of 50% may not be. What does that exactly even mean? Well, it means for most medical services the deductible needs to be satisfied for the insurance to pay claims. That means 8k out of your pocket BEFORE the insurance pays claims. NOT IDEAL! In addition, “coinsurance” is the share amount between you and the insurance company AFTER your deductible is met. So, if it’s 50% that means it paying only half the claims after your deductible. I recently saw a short-term medical plan that had a coinsurance of 15k every 6 months, so that’s 30k per calendar year. Do the math. You are looking at a hefty out-of-pocket expense! Ideally, we pay a monthly premium to cover our medical costs if they arise. 15 min can save you thousands a year not only in monthly premiums but out-of-pocket exposure in the event of a major medical event. Reach out & schedule a free consultation today and speak with a licensed benefit advisor, review ALL avilable coverage options prior to selecting a plan.

Health Coverage & Self Employed

Being your own boss is exciting! You’re in control and doing something that more than likely you’re passionate about! Being self-employed could mean anything from owning your own business to working a steady freelance contracting gig. Whatever it is, you’re walking the tightrope of being your own boss and being in charge of everything including your health coverage. That’s where things can not only get confusing but costly. Being self-employed, you miss out on the luxury of having employer-sponsored health plans that your employer paid upward of 50% of the monthly premium. If your business is booming and you do not receive any subsidies for reduced monthly premiums on the marketplace exchange. You could be paying a pretty penny for health coverage. Coverage that you don’t even use too often. Owning your own business is a big deal. Making sure you have the right coverage being self-employed is also a big deal. Being self-employed & healthy can benefit you when it does come to coverage options. Private options with nationwide PPO networks, can not only be more affordable if you can qualify but reduce your out-of-pocket exposure without jeopardizing levels of coverage. Which is very important for someone running a business. If you are self-employed and feel you are overpaying or starting to looking into your own health coverage option. reach out today and let a benefit specialist show you all your available options and advise and educate you through the process to determine which plan is best for you.

Health Coverage for Nurses

The past almost 2 years have been well, a lot on our nurses. From being on the front lines, being hero’s saving lives, to being overworked and understaffed. They have been through and risked their health the most in the few years. Our nurses of course have to protect themselves as well.  Now a good portion of nurses have health coverage through their employer which is great bc they are at a minimum paying 50% of monthly premiums.

What about our travel nurses? Who basically jump Into the fire of the hotspots of covid-19. Unfortunately, for most travel nurses, health benefits are not offered to them. So they check the marketplace exchange and realize they can get coverage but it’s in a restricted HMO or EPO network that only covers in that specific zip code they reside in. Unfortunately, that type of network wouldn’t be sufficient for a travel nurse, simply bc when they now travel outside of their resident zip code they have no coverage. Risking and jeopardizing your health daily working in covid hotspots and not having the proper coverage isn’t a risk I would advise taking.

Most people, nurses especially would benefit from being in a nationwide PPO network. Where you have coverage anywhere in the nation and have the freedom and flexibility to even go outside of the network if need be. Now, PPO networks are extremely limited on the federal marketplace exchange. They are available on the private market. If you are a travel nurse and do not have the right coverage for you or no coverage at all reach out today speak to a benefit specialist to review all your available coverage options. Even if you are not a nurse and travel frequently being in a nationwide PPO network would benefit you. You want to be covered anywhere you go, being in a nationwide PPO network provides that!

Overpaying for Health Coverage that you don’t use?

Health Coverage is designed for you an individual to pay medical claims that typically we wouldn’t be able to afford. Of course, we want it coverage our small claims as well. However, the main purpose of health coverage is to cover catastrophic claims, that’s the real reason why we obtain health coverage. We don’t get auto insurance for oil changes and tire rotations, we get it for the major stuff. However, without receiving a government subsidy to reduce premium costs. Plans on the federal exchange can be well, expensive. With large out-of-pocket exposure. Now for someone who doesn’t use their health coverage very often and is relatively healthy. Why are they going to want to overpay for health coverage they do not use? Fortunately, when relatively healthy there are plans on the private market that are based upon health NOT income like it is on the marketplace exchange. These plans are typically in nationwide PPO networks that do not limit your network like HMO & EPO networks, they typically carry very low out-of-pocket exposure and carry very affordable monthly premiums. You ask how is that possible? Well, Insurance in its self is about risk pooling. When the risk pool is unhealthy and you have guaranteed issued plans like on the marketplace exchange, more claims are going to be submitted. The insurance company has to offset the claim loss they are going to receive. How do they do that? They raise the monthly premiums and out-of-pocket exposure. A healthy risk pool has fewer claims naturally, which in turn the insurance company can reduce monthly premiums and out-of-pocket exposure. Now, this isn’t saying that the marketplace is a bad thing bc, in fact, it’s great for individuals who do make a lower income and can qualify for a subsidy and or have major medical issues, bc they cannot be denied coverage on the marketplace per the ACA. However, if you are healthy and or do not receive a government subsidy for reduced premiums there are more affordable coverage options with less out-of-pocket exposure available. I always advise you to review all your coverage options and to speak with a licensed specialist prior to making any decisions regarding coverage. Reach out today and speak to one of our licensed benefit specialists and review all your avilable coverage options.