How does the Inflation Reduction Act affect your Health Coverage?
Inflation Reduction Act and Health Coverage
How the Inflation Reduction Act Affects Your Health Coverage
The Inflation Reduction Act (IRA) reshapes how Americans pay for health coverage. If you’re self-employed, between jobs, or comparing Marketplace plans with Private PPO options, these changes can directly affect your premiums, subsidies, and prescription costs. Here’s what it actually does and what to review before you renew.
What the Inflation Reduction Act Actually Does
Lower Marketplace Premiums
- Extends enhanced ACA subsidies that reduce monthly premiums for many households.
- More middle-income families qualify for assistance than before.
- Helps keep Marketplace plans competitive versus employer coverage.
No Sudden “Subsidy Cliff”
- Premium tax credits phase out gradually instead of cutting off at one income number.
- Savings scale with income, which helps freelancers and self-employed families.
- Gives more flexibility if your income fluctuates year to year.
Help With Prescription Costs
- Caps some out-of-pocket prescription costs in Medicare over time.
- Limits how fast certain drug prices can increase each year.
- Can ease pressure on overall family health budgets, especially for seniors.
Stronger Consumer Protections
- Makes it harder for plans tied to the ACA to shift large costs back onto families overnight.
- Encourages carriers to keep preventive and chronic-care benefits affordable.
- Supports more predictable pricing from year to year.
How It Affects Marketplace vs. Private PPO Plans
Marketplace (ACA) Plans
- Premiums are heavily influenced by IRA-extended subsidies and your household income.
- Great fits when tax credits keep monthly premiums low.
- Networks may be narrower (HMO/EPO), and referrals are common in many areas.
Private PPO (Non-Marketplace)
- Do not receive IRA subsidies—pricing is based on age, ZIP, benefits, and network size.
- Can offer nationwide PPO access with no referrals when medically underwritten.
- Often a better fit when keeping specific doctors, hospitals, or travel flexibility is the priority.
What To Do Before You Renew or Switch Plans
- Review income for next year. Estimate your 2026 household income as realistically as possible so subsidies are accurate.
- Compare Marketplace vs. Private PPO side by side. Look at doctors, prescriptions, deductibles, and total yearly cost—not just the premium.
- Check doctors and meds first. Confirm that your preferred providers and key prescriptions are covered under any new option.
- Avoid auto-renewing blindly. Plan designs and subsidies change; the plan that fit last year may not be the best fit now.
Want help sorting out IRA rules in your ZIP?
We’ll verify your doctors and prescriptions, compare Marketplace options with Private PPO plans, and show clear side-by-side costs—no pressure, just answers.
FAQ
Will the Inflation Reduction Act always keep my premiums low?
Not automatically. The IRA extends and adjusts subsidies, but your premium depends on income, age, ZIP code, and plan type. It’s important to review options each year.
Does the Inflation Reduction Act help with Private PPO plans?
No. IRA subsidies apply to ACA Marketplace coverage. Private PPO options are priced differently but can still be cost-effective when you need broader networks or no referrals.
Do I still need to report income changes?
Yes. If you use Marketplace coverage, you should update income and household changes so subsidies stay accurate and you avoid surprises at tax time.
Robert Adams
https://www.RKAInsuranceAdvisors.com
H.R.5376 - Inflation Reduction Act of 2022 was signed into law by Biden on 08/16/2022. Many argue whether this bill will help reduce inflation or not. That topic may be subjective to a degree, per each individual. We are here to discuss how this law directly affects your health coverage and the facts surrounding this bill's direct impact on Healthcare. Not to project our opinions or give a political spin.
Part 1-- Addresses prescription drug costs.
Lowering Prices Through Drug Price Negotiation. The bill requires the Centers for Medicare & Medicaid Services (CMS) to negotiate the prices of certain prescription drugs under Medicare beginning in 2026. Specifically, the CMS must negotiate maximum prices for brand-name drugs that do not have other generic equivalents and that account for the most significant Medicare spending. The CMS must negotiate the prices of 10 drugs in 2026, 15 in 2027 and 2028, 20 in 2029, and each year thereafter. Drug manufacturers that fail to comply with negotiation requirements are subject to civil penalties and excise taxes.
Part 2--Prescription Drug Inflation Rebates
In addition to negotiations, the bill requires drug manufacturers to issue rebates to the CMS for brand-name drugs without generic equivalents. Under Medicare, that costs $100 or more per year per individual, and for which prices increase faster than inflation. Manufacturers that fail to comply are subject to civil penalties. The bill provides funds through FY2031 for the CMS to implement the rebate programs.
Part 3--Part D Improvements and Maximum Out-of-Pocket Cap for Medicare Beneficiaries
The bill eliminates beneficiary cost-sharing above the annual out-of-pocket spending threshold under the Medicare prescription drug benefit beginning in 2024 and caps annual out-of-pocket spending at $2,000 in 2025 (with yearly adjustments thereafter). It also establishes a program under which drug manufacturers provide discounts to beneficiaries who have incurred costs above the annual deductible beginning in 2025. The bill provides funds through FY2031 for the CMS to implement these changes and requirements. The bill also establishes a process through which certain beneficiaries may have their monthly out-of-pocket costs capped and paid in monthly installments beginning in 2025. It provides funds for FY2023 for the CMS to implement this process.
Part 4--Continued Delay of Implementation of Prescription Drug Rebate Rule
The bill further delays until 2032 implementation of a Department of Health and Human Services rule relating to the treatment of certain Medicare prescription drug benefit rebates from drug manufacturers for federal anti-kickback laws.
Part 5--Miscellaneous
The bill establishes additional programs and requirements relating to coverage under the Medicare prescription drug benefit and other programs. For example, the bill eliminates cost-sharing under the Medicare prescription drug benefit for adult vaccines recommended by the Advisory Committee on Immunization Practices.
It also requires coverage, without cost-sharing, of such vaccines under Medicaid and the Children's Health Insurance Program (CHIP).
In addition, the bill caps cost-sharing under the Medicare prescription drug benefit for a month's supply of covered insulin products at (1) for 2023 through 2025 $35; and (2) beginning in 2026, $35, 25% of the government's negotiated price, or 25% of the plan's negotiated price, whichever is less. The bill provides funds for FY2022 for the CMS to implement these provisions.
Subtitle C--Affordable Care Act Subsidies
The bill extends 2025 certain adjustments and expansions of the premium tax credit, allowing taxpayers with income above 400% of the federal poverty line to qualify for the credit. Meaning the additional subsidies approved with the passage of the American Rescue plan were extended. Initially, there was an expectation that they would have expired.
Those are the facts of this bill that is now signed into law. We also know, and it's being reported, the expected price increase for 2023 marketplace plans. The analysis finds that the median proposed rate increase is 10% across 72 insurers in the markets reviewed. Insurers' rate requests are preliminary at this point. As a result, they may change during the review process before being finalized in early fall. Please be sure to reach out with any questions about this bill, rates, or general insurance. Our goal is to advise and educate.
HOW TO PREPARE FOR OPEN ENROLLMENT AND WHAT TO EXPECT
HEALTH INSURANCE OPEN ENROLLMENT REMINDER
Open enrollment is the time of year when you can sign up for health insurance or change your current plan on the government marketplace. The open enrollment period for the marketplace is available from November 1, 2022– January 15, 2023. With coverage to begin January 1, 2023, so long you enroll before December 15, 2022. From December 16, 2022, to January 15, 2023, plans will start on February 1, 2023.
Before you dive in and start shopping around, it's essential to ensure you're prepared and educated for what lies ahead. So here are some tips on how to get ready:
Check if your income has changed from what you previously reported. Any underreporting income can result in a tax penalty when you file taxes.
Know what you are looking for, HMO, EPO, or PPO. High Deductible & Lower Premium? Or Low Deductible & Higher Premium?
Know what your max out-of-pocket will be in the event of a significant medical claim.
Understand the above insurance terms & what they mean.
Are your medical providers within your chosen plan's network?
Has there been a diagnosis of a pre-existing condition?
Did you move & are unsure if your current plan will cover you in your new area?
Know Your Options - Ensure you understand what coverage is available to you. You may want to consider buying coverage through the marketplace or getting a private plan outside of the marketplace.
Speaking to a Licensed Health Coverage Advisor is always the course of action. Our priority is to answer any questions you have and offer an educational approach to individual coverage in today's market.
What to Expect
Suppose you're currently enrolled in a plan through the marketplace. In that case, you can expect to receive information about open enrollment from your insurance company. You may also see open enrollment reminders on this website and social media.
This year there will be substantial changes to this open enrollment. Some of those changes are insurance carriers leaving specific markets and others adding plan options to others.
A few things have contributed to the above-average increases this year, such as inflation & Covid-19. Additional subsidies, also known as cost-sharing reduction, will continue into this year's Open Enrollment. Therefore, if you are receiving a subsidy, you may receive a notification about potential changes to premium costs.
It will be imperative in the event you do, you speak to a licensed health coverage advisor. By not doing so, you may be subjecting yourself to overpayments of premiums or potential penalties for income reporting.
Marketplace plans, although an excellent option to obtain coverage, due to ACA laws & protecting the rights of individuals to get coverage. The marketplace, however, is not the only place health coverage is available.
Finally—and most importantly—it's crucial that everyone speak to a licensed advisor when considering any change! We know how confusing these situations can be; that's why we're here for you at every step!
Be proactive and reach out to us today regarding any questions you may have or quotes you need. Let us assist you in determining which coverage provides you with the most protection at the most affordable rates.
What Is A PPO Health Insurance Plan?
What is a PPO Health Insurance Plan?
You may have heard the term PPO & HMO, maybe even nodded your head in conversation and acted as if you know precisely what a PPO is. You may know it's popular and realize it's better than an HMO. But when it comes to many of these different insurance terms, it leaves you scratching your head.
With all the different insurance terms, such as PPO, HMO, EPO, Deductibles, Max out of Pocket, Coinsurance, etc. Were going to focus on what is PPO Health Insurance in health insurance? The acronym PPO stands for Preferred Provider Organization and is one of the most popular types of coverage. PPO health insurance plans contract a network of medical providers, doctors, and facilities agreeing to charge a set rate for their services. By staying in-network, members will enjoy significant savings on all healthcare-related costs compared to seeking medical attention outside the network.
One of the most popular features of a PPO plan is its flexibility. While most health insurance plans, like HMOs, require you to select a Primary Care Physician, Preferred Provider Organizations don't. You also won't need a referral to see specialists. You even have the flexibility to go outside of the plan's network if need be.
How Preferred Provider Organizations Work
Now that you know what PPO means, let's take a closer look at this type of coverage. We briefly touched on how Preferred Provider Organizations use provider networks, but how does that save you money? Well, it boils down to this simple idea. Health insurance companies and medical providers are in the business of making money. While health insurance providers have an extensive list of members, medical providers have the skills and experience to look after the health and wellbeing of those members. They arrange a contract to provide care to the insurer's members for a predetermined contracted rate. By doing so, health insurance companies will save money by cutting costs, and medical providers will receive more business as preferred providers. The arrangement is typically a win-win situation for both parties and, most importantly, benefits you.
What's Covered?
Suppose you're purchasing a PPO insurance plan through the Marketplace. In that case, it will need to cover the minimum essential benefits mandated by the Affordable Care Act (Obamacare). On the other hand, suppose you opt to purchase health coverage outside the marketplace. In that case, your coverage will largely depend on your plan and who the insurance provider is. Although, most PPO plans provide extensive coverage as they have contracts with a large provider network at lower rates.
Flexibility
With PPOs, you don't need to choose a Primary Care Physician (PCP). Instead, you choose which doctors you want to see and how often you wish to see them. Here are three examples of why flexibility in seeking medical care can be helpful:
If you need to see a specialist, you can make an appointment without getting a referral from your primary doctor prior. Ideally, this saves you time and one less co-pay you have.
If you visit a doctor you don't like. You can make your next appointment with a different in-network doctor. No questions asked, and no waiting for approval from your insurance provider to switch doctors.
If you don't want to see a doctor for routine check-ups, you don't have to. You have the freedom to seek care whenever you want and from any doctor in your PPO network.
How Much Does A PPO Cost?
There are a few factors that determine the cost, such as age, how many people are insured, and zip code. Each plan also can differ in network size, copays, deductibles, and Max out of Pocket, which are all factored into rates. PPO plans on the marketplace are harder to come by. A large portion of country PPOs are not even available on the marketplace. If in the event they are, we generally see them much more expenses than HMO & EPO networks. Private PPO plans are available in most areas. These plans are short-term medical plans, which, although usually a PPO, provide limited benefits. Always speak to a Licensed Advisor before enrolling in any plan, especially short-term plans. Also, there are private plans that are subjected to a medical risk assessment, which typically results in more affordability bc the risk pool is healthier for individuals who have a smaller claims history. The insurance company can offer lower rates, PPO networks, and more benefits.
Where To Start Your Search
If you want to learn more about PPO health plans and whether or not it's your best coverage option, the best place to start is right here. RKA Insurance Advisors has helped thousands of individuals and families find the best policy by taking an educational approach and reviewing ALL the options available in your area. Getting started is as simple as going to our appointment page. Scheduling a time and day, you would have a few moments and speaking to one of our Licensed Advisors. We are here if it’s even to get a second opinion on your current plan. We look forward to hearing from you!
www.RKAinsuranceadvisors.com
561-806-9913
Robert@RKAinsuranceadvisors.com
Nationwide PPO Health Plans for Truckers
Not everyone knows how the trucking industry plays a vital role in our economy. CDL truck drivers are necessary for not only economic growth but the modern marketplace's ability to exist at all. Often these truckers are overworked and, in reality, not compensated enough for their role in the economy and our day-to-day lives. Without them, our lives do not function and are drastically impacted. Recently, we have seen surging prices for gas, food, and other goods. According to U.S. Bureau of Labor Statistics, this has catapulted U.S. inflation to a 40-year high in June, further pressuring all Americans, especially truckers.
As a result, truckers, in particular, have been one of the occupations hit the hardest. With record fuel prices and an occupation predicated on driving, this is not an ideal situation for truckers. In addition, many truckers are self-employed & contracted, further exacerbating the issue for them as they are responsible for all their costs.
Times like this are when you can start looking at areas to reduce cost—figuring out which areas we can cut to save some extra cash. One of the last areas truckers usually check is how much they are paying in health insurance costs. Once they have coverage, most people don't think to check to see if there are more affordable options. Or, at the very least, get a second opinion to ensure they have the best level of coverage at the most affordable rate and make sure the plan will cover you outside your resident state.
Truck drivers are among the most vulnerable workers in the U.S. labor force. They have one of the highest injury and illness rates for any occupation in America. Unfortunately, they are among the least likely to have health insurance coverage. According to HD Fleet, the average cost of a truck accident with one injured driver is $148,279. The cost can reach up to $7 million when it involves a fatality. Over-the-road and long-haul truck drivers are prone to accidents, leading to severe injuries. As a result, truck drivers end up in emergency rooms. Even using ERs for non-emergency services when it would have been much more cost-efficient for them with online telemedicine or urgent care treated by a Doctor or Nurse Practitioner. According to the U.S. Department of Transportation, long-haulers are more vulnerable to developing severe health conditions due to the nature of their job, making health insurance for truck drivers an essential need. These conditions are hypertension, insomnia, sleep apnea, spinal disorders, headaches and migraines, stress and depression, arthritis, sinus problems, and lung diseases.
The same research report highlights that prevalence of obesity in the average American worker is 31%. In addition, the prevalence of diabetes in truck drivers is 14% compared to 7% of the average American worker. The report shows that 17% of American workers don't have a health insurance plan. On the other hand, over-the-road and long-haul drivers are the most underprivileged regarding health insurance because 38% of drivers lack a proper coverage plan.
Due to the long-haul truck driver experiencing higher health risks, every truck driver needs health insurance. But unfortunately, most drivers don't have insurance to cover their health costs or their families' medical expenses.
This is why it's important for truck drivers, especially long-haul truckers, to secure Nationwide PPO coverage. Most options available on the marketplace exchange, otherwise known as ACA plans or Obamacare plans, are HMO or EPO networks, limiting your coverage area. These plans are terrific because they do accept everyone. Still, again you can be subjected to limited or smaller localized networks. Typically not allowing services to be covered outside of your resident state. That is not a good position to be on for an occupation requiring being out of the state more often than not. Also, being Self-Employed and not having a group health plan through a large employer.
PPO Networks provide nationwide access to doctors, facilities & hospitals. You have the freedom and flexibility to go to any medical provider. It's always best to stay within the provider network, of course. However, if you cannot, you'll still have coverage, which is excellent news for Self-Employed truckers. Health insurance is a considerable expense for truckers. That's why it's crucial to have a Licensed Health Coverage Advisor help navigate these complexities. The various networks and what insurance carriers have more extensive nationwide networks. Which options have unlimited telemedicine if you need a quick prescription filled, you have a 15 min phone or video consultation with a board-certified physician, and it's called into a pharmacy near your travels.
Most people are not aware of the vast amount of private nationwide PPO plans available. Most Self-Employed people prefer these plans as they are nationwide PPO plans and usually have low or no deductible options. Most of the time, extensive Networks like United, Cigna, and PHCS, to name a few.
Now not every single private plan is efficient coverage. So, again, more reason to have one of our Licensed Advisors do this work for you and with you. Frequently, this results in individuals finding comprehensive and quality health coverage that you can take anywhere with you nationwide and saving a couple of extra dollars. Saving people money and getting them in a better position with health coverage is precisely what we pride ourselves on. So reach out today and allow us to help you find the coverage that will not let you down when you need it most at a more affordable rate.
561-806-9913
Robert@RKAinsuranceadvisors.com
www.RKAinsuranceadvisors.com
Self-Employed & Health Coverage. What are my options?
It's an exciting time when we take that leap on our own to go Self-Employed & leave behind working for someone else & your traditional 9-5. There is so much that goes into that exciting decision. One of the most significant decisions is where to turn for health coverage.
Most of the time, we have jobs that pay a large portion of our health coverage costs. Most employers pay 50%, and even some will pay 100%. We put all this effort into getting our business set up, and we put in our two weeks with our soon-to-be old employer & then we get the letter stating the cost of Cobra. At that point, we typically lose the employer contribution and are subject to paying the total cost of the coverage. Most of the time, that number isn't a number we are comfortable looking at, let alone paying!
Going Self-Employed, one of the most challenging areas to navigate is obtaining health coverage, especially if you have a family. Most people go online, start browsing around & enter their information. Next thing you know, you're phone starts to ring non-stop, all while you're trying to get your new business up and running. Various companies, brokers, and agents are calling you. It's a story we are all too familiar with hearing. You see some cheap plans browsing online. Then, a little deeper look & you realize those plans do not provide many benefits at all & have a higher max out-of-pocket & deductibles than what you're used to. You may be lucky enough to be able to stumble across healthcare.gov. Losing the previous employer coverage does open a special enrollment period for you. The issue there is, that predicting the total combined household income for the year before taxes is tricky. Also, underreporting income can lead to being penalized when you file taxes the following year if you received a subsidy. Suppose your annual tax filings exceed what you reported to the marketplace. In that case, you will be responsible for paying back the subsidy amount that was provided. It's not something a new business wants to be faced with.
So, the question remains: what do you do, where do you turn?
That's an area in which RKA Insurance Advisors can help. Access to private medically underwritten plans that are not subjected or tied to your annual income are available. They are what a lot of self-employed individuals do prefer. The reason is, that often these plans will be much more affordable than the offerings of Cobra from your previous employer. Unless receiving a subsidized premium on the marketplace, these options will also be more affordable. These plans will have large nationwide PPO networks, where you are covered nationally. Not just the localized coverage like many of the HMOs found on the marketplace. Being medically underwritten ensures the risk pool is healthier individuals; therefore; as a result, rates and out-of-pocket exposure are usually lower because there is less claim loss. Some of these options are guaranteed renewable to age 65. Some are designed specifically for a more affordable option with many benefits upfront without meeting a deductible. There are also select guaranteed issued private plans not based on medical history. Each person & their situation, needs, and budget are different. When deciding to go self-employed, it's always best you speak with a licensed Health Coverage Advisor.
RKA Insurance Advisors can and will ensure to go through ALL your available options with you. Educating you on the important things when selecting a plan. Such as the different networks, making sure your doctors & facility are within the plan's network, & going over co-pays for services, deductibles, and max-out-of-pocket. All the what-if scenarios that may occur. We specialize & pride ourselves in delivering the best understanding of health coverage. How to get the most out of your coverage and provide the education to determine which plan(s) best suits you in your new endeavor of going self-employed. Reach out to us via Email, call, or text. You can schedule a time and day for an appointment directly on our website.
We look forward to hearing from you!
www.RKAInsuranceadvisors.com
561-806-9913
Robert@RKAInsuranceadvisors.com
Potential Cost Increase in Marketplace Coverage for 13 million Americans.
Every day isn’t a good day in the health insurance industry. With premiums set to raise upwards of 50% for individuals that have coverage through the Marketplace (also known as the ACA, or ObamaCare.) In 2021 Congress signed the “American Rescue Plan” into law on March 2021, which increased the subsidy income cap to receive a subsidized premium. Of the 14.5 Million enrolled in a government, 13 Million receive subsidized premiums. If you are one of the ones who does have coverage through the Marketplace & receive a subsidized premium, expect higher premiums next year. Unless Congress acts quickly, enhanced subsidies you’ve been receiving for the last two years will disappear, affecting roughly 13 million Americans.
Most Enrollees, including self-employed & workers with no job-based health coverage, will be significantly affected. It’s uncertain whether Congress will revive the provision via other legislation that may try to get through before Open-Enrollment.
Here’s a hypothetical example, based on a report from the Congressional Budget Office: A 64-year-old with $58,000 in income — about 430% of the 2022 poverty level of $13,590 — has insurance through the Marketplace. The 8.5% limit currently in place means they would pay no more than $4,950 for premiums this year. However, if faced with a 400% cap on eligibility in 2023 (which it was before the “American Rescue Plan”), that same person would pay $12,900 for premiums annually because they’d no longer qualify for subsidies.
This is precisely what we are here for. The Marketplace isn’t the only way to secure coverage. Private Options, not subjected and based on your income, are available. These options are based on a health risk assessment to determine eligibility. These plans, on avg, are more affordable and provide lower deductibles & out-of-pocket exposure. In addition, Nationwide PPO networks. Even some options are guaranteed renewable till age 65. It’s important to speak to one of our licensed health coverage advisors to determine if you can be eligible for these options. Regardless of your current coverage situation, it’s essential to ensure you are in the best possible position from a coverage & cost standpoint. We are here to help. Reach out today if you are insured through the Marketplace, have general questions, need quotes, and want to compare options. Our team of licensed specialists will be here for you.
Nationwide PPO Health Plans
There is good news in the world of health insurance! Yes, I know, finally! This time of year, the only options usually available are Limited Benefit Plans, Short Term Medical Plans, and HealthShare plans. Which are not full coverage, and provide limited benefits that can leave you exposed to a lot of claims left unpaid. Unless of course, you have a qualifying life event, then you have the ability to shop marketplace options. Depending on the person, income, medical history & situation even those plans might not be the best fit for you.
Recently released, is a new medically approved plan. Designed to offer lower out-of-pocket exposure, lower deductibles, and more upfront benefits where a deductible doesn’t have to be met to cover services such as Dr visits, specialist visits, prescriptions, labs, X-rays, MRIs, and many more services. In addition to that, it offers nationwide coverage through one of the largest PPO networks in the country. Of course, there are already in existence medically approved plans that are guaranteed renewable to 65 as well.
With the rising cost of services and goods recently. Its important to always check your expenses to see if there are any potential savings. For anyone who has been affected by the recent rise in costs of things such as gas & food, and is currently insured, reach out! We can review your current health coverage costs & levels of care. Compare to existing and new plans released. It’s very likely you could be overpaying. In the event you aren’t taking a few minutes to reassure you are in a good position is worth it. Send us a message, call, or e-mail, and one of our state-licensed advisors can answer any questions or guide you through the available options with an educational approach!
What to do when you need coverage & it’s not Open Enrollment?
It’s a scenario that happens all too often. Losing health coverage can be a nerve-wracking thing to happen. It could be for various types of reasons. Lost employer coverage due to change of employment, termination, or lay-off. Maybe you decided to go Self Employed, recently moved, or policy lapses bc you forgot to pay. There are many reasons why you can lose coverage outside of open enrollment.
The good news is you might not be as out of luck as you think you are!
There are various things that can trigger, what’s called a “special enrollment period” for the government marketplace plans. Some of those things are:
Lost coverage within the past 60 days
Change of primary living in the past 60 days
Birth or death in the household in the past 60 days
Change in eligibility status in the past 60 days
Married or divorced
This is really good news as it opens the doors to guaranteed issued plans, that you can be approved for regardless of medical conditions. As a result and to compensate for claim loss, these plans can have really high out-of-pocket expenses & deductibles. Unless monthly premiums are subsidized, they can be really expensive.
Also, at any time of the year, private health plans are available 365 days a year. Most of these options (not all) are based upon health history and you do need to be approved. However, there are options that are guaranteed renewable till 65.
Private options bc the risk pools are healthier typically do have a larger network of providers, lower monthly costs, lower deductibles, and lower out-of-pocket responsibility, all without jeopardizing coverage. Now, these plans are not for everyone. That’s exactly why it’s important to speak with one of our licensed health advisors so they can understand your situation, help navigate the hundreds of different plans and narrow down to which is the best plan for you. That way you are not subjected to overpaying for coverage and know exactly how to get the most out of your health plan.
If it’s just comparing your existing coverage, a recent loss of coverage, general questions, or just a quick quote. Reach out today and speak with one of your licensed specialists.
Missed Open-Enrollment?
If you missed 2022 open-enrollment period, you may be asking yourself what do I do & can I still secure coverage? The short answer is YES. The long answer is……
Outside of the open enrollment period options can of course be limited. First, if you still are uninsured for 2022, we can always check to see if you qualify for a special enrollment on the marketplace. What is that exactly? Simply means you have had a qualifying life event, some of which are, loss of coverage in the past 60 days, change of primary address, change of household size, just to name a few.
Also, there are what’s called medically underwritten or medically approved options. These options can be very hard to be approved for bc they are based upon health history. Not everyone can qualify for this option. However, if you can it usually leads to more affordable premiums, nationwide PPO networks & lower out-of-pocket exposure. Some of these options are guaranteed renewable till age 65 as well.
Then there are short-term medical plans, Indemnity plans & health-share plans as well. Usually, these options can work to fill a gap whereas you only need coverage for a month or so. These plans typically are really cheap as well. As a long-term solution, these options can lead to having to pay a lot more out of pocket for your medical expenses.
If you haven’t secured coverage 2022 yet, schedule an appointment, send us a message, or give us a call. Our team of licensed advisors are here to answer any questions you may have. There is no cost to review your options. Also, if you aren’t satisfied with your current plan you do not have to wait till the next open enrollment. Reach out and review your options & see where and what options you can qualify for.
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
Open Enrollment has been extended through January 15, 2026. Don't miss your last chance to enroll in Marketplace or Private PPO health insurance for 2026. Get free quotes from licensed advisors today.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
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.
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.
