Preparing for Open Enrollment 2026: Key Steps Every Consumer Should Know

Open Enrollment 2026 runs Nov 1, 2025 – Jan 15, 2026. Learn key deadlines, cost trends, and smart moves to compare ACA Marketplace vs. private PPO options. Get guidance from RKA Insurance Advisors to lock the right coverage before prices ju

Preparing for Open Enrollment 2026: Dates, Deadlines, and Smart Moves

Enrollment Help • Updated for 2026 • Written By Robert Adams

Fast take: For most states, Open Enrollment runs Nov 1, 2025 – Jan 15, 2026. Enroll by Dec 15 for a Jan 1 start; enroll by Jan 15 for a Feb 1 start. We compare Marketplace (government) vs. Private PPO (licensed access) side-by-side, verify doctors & prescriptions, and lock 2026 costs—no pressure, just answers.

Need help choosing the best fit in your ZIP?

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

Why costs are climbing

  • Medical inflation: Hospital, physician, and facility prices continue to outpace wage growth.
  • Rx trend: Specialty drugs (including GLP-1 therapies) are widening spend.
  • Higher utilization: Delayed care is catching up, pushing claims higher.
  • Plan design shifts: Employers may raise deductibles/copays or adjust contributions.

What to compare during open enrollment (October–December)

Marketplace (Government)

  • Premium tax credits available if income qualifies.
  • HMO/EPO networks are common; referrals often required.
  • County-based networks; choices vary by ZIP.
  • Available during Open Enrollment or a qualifying life event.

Private PPO (Licensed Access)

  • Broad PPO access; referrals typically not required.
  • Medically underwritten—can be lower-cost for healthy households.
  • Often better for travel, provider choice, or specialist access.
  • Available year-round (subject to eligibility and effective-date rules).

Key 2026 enrollment timing

  • Enroll by Dec 15, 2025 for coverage starting Jan 1, 2026.
  • Enroll by Jan 15, 2026 for coverage starting Feb 1, 2026.
  • State-based exchanges may vary—ask us to confirm your state’s exact dates.

How RKA helps (no pressure—just answers)

  • Side-by-side comparisons: Marketplace vs. Private PPO, matched to your doctors and prescriptions.
  • Network & Rx checks: We confirm providers and tiers up front to prevent surprises.
  • Year-round support: We stay with you for renewals, plan changes, and claims questions.

Want a side-by-side Marketplace vs. Private PPO analysis?

We’ll verify networks and medications, compare plans in your ZIP, and show clear costs—no pressure, just answers.

Quick FAQs

Is the employer plan always best?

Not always. If spousal or child premiums are high, placing them on Marketplace or Private PPO can cut total household cost while keeping access. We’ll model both paths.

Can you verify our doctors and hospitals first?

Yes. We confirm providers and prescriptions up front so you avoid out-of-network surprises or Rx tier shocks later.

Can we switch mid-year?

Generally only with a qualifying life event. Otherwise, Open Enrollment is your main window. Private PPOs may offer licensed access year-round if eligible.

Educational use only; benefits and eligibility vary by employer, carrier, and state. Always review official plan documents.

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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.

Not sure which network fits your doctors and travel?

We’ll verify your providers and prescriptions, compare HMO vs PPO vs EPO vs POS, and show clear out-of-pocket costs.

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.

We’ll match the network to your doctors and travel

Send your provider list—primary care, specialists, hospitals—and we’ll confirm participation and show total annual cost.

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.

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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.

Not sure which option fits you best?

We’ll compare ACA Marketplace plans, private PPOs, and employer coverage to match your doctors, meds, and budget.

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.

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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.

Need help choosing the right network for your team?

We’ll audit your employees’ key providers, compare PPO vs HMO costs, and design contributions that fit your budget.

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.

Get a side-by-side PPO vs HMO analysis for your business

Send your provider list and locations. We’ll verify networks, project total annual cost, and recommend a clear path.

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.

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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.

Want us to sanity-check your income estimate?

We’ll model scenarios for W-2 and self-employed income, adjust your Marketplace application, and keep your credits accurate.

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

  1. Estimate annual MAGI (with a conservative range).
  2. Choose a plan; take only the advance credit you’re comfortable with.
  3. Track YTD income and adjust through your Marketplace account when needed.
  4. 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.

Keep your credits accurate—no surprises at tax time

We’ll help you update your Marketplace application and compare ACA vs. PPO options as your income changes.

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.

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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

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.

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 • President & Licensed Agent • NPN 19540130
Licensed in AL, CO, DE, FL, GA, IA, IL, IN, KY, KS, LA, MD, MI, MO, MS, MT, NC, NE, NV, OH, OK, SC, SD, TN, TX, UT, VA, WI, WV, WY
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Year-Round Health Insurance Options: Finding Coverage Anytime, Anywhere

Year-Round Health Insurance Options: How to Get Covered Outside Open Enrollment | RKA

Coverage Guide

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

Missed Open Enrollment? You still have options. Depending on your situation, you may qualify for a Special Enrollment Period, Medicaid/CHIP, or a private, medically underwritten PPO. RKA verifies doctors, prescriptions, and costs side-by-side so you don’t overpay—or go uncovered.

What “year-round options” really means

Outside the annual Open Enrollment window, these paths can unlock coverage:

1) Special Enrollment Period (SEP)

  • Triggering events: loss of employer coverage, move to a new state, marriage/divorce, birth/adoption, household income change, and more.
  • Timing matters: most SEPs provide a 60-day window from the event date—earlier action = more plan choices.
  • We help: confirm eligibility, compare plans, and submit the right documentation to avoid delays.

2) Medicaid & CHIP (year-round)

  • Income-based programs with comprehensive benefits; eligibility varies by state and household size.
  • Enrollment is open all year—no need to wait for Open Enrollment.

3) Private, medically underwritten PPOs

  • For healthy individuals/families who qualify, these plans can offer lower premiums, nationwide PPO access, and predictable costs.
  • Eligibility depends on health history; we pre-screen quickly and verify your doctors and facilities.

4) COBRA & short-term options

  • COBRA: convenient continuation of employer coverage, but often expensive (full premium + admin fee).
  • Short-term medical: limited, temporary coverage and rules vary. Good for narrow gaps; not a long-term substitute.

How we keep you covered without overpaying

  • Doctor & Rx checks: we confirm networks and drug tiering before you enroll.
  • Cost projection: premium + likely usage to estimate your real annual cost.
  • Fast placement: we handle the paperwork and keep your start date on track.

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

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Health Insurance for the Self-Employed: A Comprehensive Guide

Coverage Options • Enrollment Help Oct 24 Written By Robert Adams

Health Insurance for the Self-Employed: A Comprehensive Guide

Fast take: Without an employer plan, self-employed workers have three practical paths: ACA Marketplace, private (medically underwritten) PPOs, and short-term bridge coverage. We compare them side-by-side, verify your doctors and meds, and show clear costs—no pressure.

Need help choosing the best fit in your ZIP?

We’ll verify your doctors and prescriptions, compare Marketplace vs. Private PPO, and show clear costs—just answers.

Challenges of Self-Employed Health Insurance

  • Variable income: budgeting premiums can be tricky when revenue fluctuates.
  • No employer contribution: the full premium falls on you without cost-sharing.
  • Too many choices: ACA vs. private PPO vs. short-term can feel overwhelming.

Main Coverage Options

ACA Marketplace (Government)

  • Premium tax credits may lower costs if income qualifies.
  • Networks: HMO/EPO are common; referrals often required; networks vary by county/ZIP.
  • Timing: available during Open Enrollment or special enrollment after qualifying life events.

Private PPO Coverage (Licensed Access)

  • Nationwide PPO access when eligible; typically no referrals to see specialists.
  • Underwriting: medically underwritten—healthy applicants may see lower premiums.
  • Good fit: keeping specific doctors/hospitals, frequent travelers, out-of-state care.

Short-Term Health Insurance (Bridge)

  • Temporary: coverage for a few months up to a year; not a long-term solution.
  • Use case: bridging gaps between jobs or enrollment periods.

Supplemental Coverage

  • Accident, critical illness, hospital indemnity can reduce out-of-pocket exposure alongside your main plan.

Dental & Vision

  • Affordable add-ons for cleanings, dental work, eye exams, glasses, and contacts.

Tax Advantages for the Self-Employed

Many self-employed professionals can deduct premiums for themselves, a spouse, and dependents using the Self-Employed Health Insurance Deduction. Always confirm details with your tax advisor.

What to Do First (Takes 5 Minutes)

  1. Gather quick proof: business/1099 income docs; prior coverage details if switching.
  2. List providers & meds: the doctors/hospitals you want to keep; current prescriptions (name + dosage).
  3. Decide priorities: lowest premium vs. broader network; referrals OK vs. prefer no referrals; travel out of state?

Get Expert Guidance Today

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

Robert Adams | RKA Insurance Advisors

Quick FAQs

  • Can I enroll outside Open Enrollment? Yes, with a qualifying life event; otherwise we can explore private PPO eligibility or short-term bridge options.
  • Will my doctors be in-network? We verify networks on both ACA and private PPO options before you enroll.
  • Can I keep HSA access? If needed, we’ll identify HSA-eligible options, but we won’t push HSA/HRA—fit first.
self-employed health insurance • ACA Marketplace • private PPO • PPO alternatives • Open Enrollment
Robert Adams
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Open Enrollment 2026: What You Need to Know

Premiums are rising again. 2026 Marketplace plans are pricier with higher deductibles and OOP limits. Here’s what’s driving it — and how to compare Marketplace vs Private PPO options before Open Enrollment.

Open Enrollment 2026: What You Need to Know

Oct 15 • Written By Robert Adams
Fast take: ACA health plan rates and benefits can change for 2026. Open Enrollment is your yearly window to switch plans, verify your doctors, and lock in coverage dates. Here’s the 2-minute rundown and how we’ll compare options for you.

Important dates

Open Enrollment Window Nov 1, 2025 → Jan 15, 2026
Enroll by Dec 15 Coverage starts Jan 1, 2026
Enroll by Jan 15 Coverage starts Feb 1, 2026

Get Expert Guidance Today

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

What’s changing for 2026?

  • Medical inflation & utilization: Hospital and provider costs continue to ripple through next year’s premiums.
  • Prescription drugs: High-cost specialty meds remain a driver; formularies and tiers can shift.
  • Subsidy math: Income and household size determine savings. We’ll confirm your eligibility band before you choose.
  • Networks: HMO vs PPO vs EPO—pick based on the doctors/hospitals you actually use, not just the premium.

How to choose the right plan (quick framework)

  • Doctors & facilities first: We confirm in-network status and referral rules.
  • Rx check: We price your actual meds across plans (tier, prior auth, step therapy, mail-order).
  • True annual cost: Compare premium + expected usage (copays/coinsurance + deductible + max out-of-pocket).
  • Access & travel: If you need multi-state flexibility or out-of-network options, consider PPO over HMO.

Quick FAQs

When should I enroll?

Enroll early. Dec 15 starts Jan 1 coverage; Jan 15 starts Feb 1 coverage.

Can private PPOs be cheaper than Marketplace?

Yes—especially for healthy households that don’t qualify for large subsidies. We’ll model both paths.

Can you confirm my doctors and hospitals?

Absolutely. We verify providers and prescriptions before we present options.

Bottom line

Open Enrollment 2026 is your chance to realign cost, access, and coverage. We’ll do the homework—net cost, doctors, medications, and network rules—so you can enroll with confidence.

Robert Adams • President & Licensed Agent • NPN 19540130
Licensed in AL, CO, DE, FL, GA, IA, IL, IN, KY, KS, LA, MD, MI, MO, MS, MT, NC, NE, NV, OH, OK, SC, SD, TN, TX, UT, VA, WI, WV, WY
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2025 vs. 2026 Marketplace Health Plans: Why Costs Are Jumping and What to Do Now

OPEN ENROLLMENT 2024

Open Enrollment • Nov 2 • Written by Robert Adams

2025 vs. 2026 Marketplace Health Plans: Why Costs Are Jumping and What to Do Now

Fast take:

2026 Marketplace plans are coming in higher than 2025 — and the max out-of-pocket limits are climbing too. At the same time, the federal fight over enhanced ACA subsidies means some families will see their net premiums rise even if their income stays the same. Best move: let us run Marketplace vs. Private PPO vs. COBRA escape for your exact household before you lock in the wrong plan.

2025 Marketplace — baseline
  • • Lower monthly premium than 2026 for same family profile
  • • Max OOP was lower
  • • Enhanced subsidies still helped a lot of ZIPs
2026 Marketplace — what you saw
  • • Same kind of plan, higher premium
  • Higher max out-of-pocket — bad for families that actually use care
  • • If enhanced subsidies roll back → net cost goes up again

Why are 2026 numbers worse?

What you noticed in Healthcare.gov was real — not a glitch. A few things are stacking at once:

  • Medical trend & claims are higher → carriers file higher premiums.
  • Max out-of-pocket is indexed → it creeps up every year, so 2026 is just… more.
  • Subsidy uncertainty → if enhanced credits are rolled back, you feel the full hike instead of it being hidden by APTC.
  • Family of 4 = multiplier → higher OOP hurts more when it’s 4 people hitting deductibles, RX, and visits.

What this means for a family of four (your example)

You were looking at a pretty normal setup — two 36-year-old adults, two kids. In 2025, you could still find a Marketplace EPO/Bronze that didn’t look insane. In 2026, that same lane is now showing:

  • • Monthly premium noticeably higher
  • • Deductible still high
  • • Max OOP even higher → this is the real pain number

That’s exactly why we tell families: don’t shop Marketplace in a vacuum. Run it next to a private, medically underwritten PPO and, if you just lost a job, a COBRA-exit strategy.

Let’s lock the right 2026 plan for your ZIP.

We’ll run Marketplace vs. Private PPO vs. COBRA escape for your exact family of 4, verify doctors, and tell you which enrollment window you’re actually in.

What to do right now

1) Send household details

Ages, ZIP, income range → we can see if credits still help you.

2) Tell us your doctors

We’ll verify networks — 2026 plans don’t all keep the same providers.

3) Compare 3 paths

Marketplace (2025 vs 2026) • Private PPO (if eligible) • COBRA exit if you got laid off.

Quick FAQs

Will everyone see 2026 go up?

Not everyone — but families that don’t qualify for strong credits will feel it the most. That’s why we try to keep you in a credit-eligible lane or move you to a private PPO if that’s cleaner.

What if enhanced ACA subsidies get extended?

Great — we’ll re-run it. But you shouldn’t plan your whole year on Congress doing the right thing. Lock a plan that works even if credits shrink.

Can I switch mid-year if 2026 is too high?

Sometimes — if you get a Qualifying Life Event or if you’re eligible for a private PPO that takes applications year-round. That’s why we map both.

Robert Adams

RKA Insurance Advisors • Private & Marketplace Health Coverage • 561-806-9913robert@rkainsuranceadvisors.com

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Navigating the Changes and Important Updates for the 2024 Open Enrollment Season


Navigating the Changes and Important Updates for the 2024 Open Enrollment Season:

As the year unfolds, so does the healthcare landscape, bringing with it new opportunities and considerations for individuals and families. The 2024 open enrollment season is just around the corner, and it's crucial to stay informed about the changes and updates that will shape your healthcare decisions. At RKA Insurance Advisors, we are committed to providing you with the latest insights and guidance to ensure you make informed choices about your health coverage. In this article, we'll explore the key changes for 2024 open enrollment, shed light on the availability of private medically underwritten PPO plans year-round, and emphasize the importance of consulting licensed health advisors or brokers throughout the process.

What's New for the 2024 Open Enrollment Season?

Each open enrollment season brings its own set of changes and updates that can impact your healthcare coverage. For 2024, here are some of the important developments to be aware of:

  1. Extended Enrollment Periods: Many states and insurance providers are extending the open enrollment period to provide individuals and families with more time to select the right healthcare plan. This extension offers added flexibility, enabling you to thoroughly research and compare different options.

  2. Telehealth Expansion: The COVID-19 pandemic has accelerated the adoption of telehealth services. In 2024, more insurance plans will likely include expanded telehealth coverage, allowing you to access medical consultations conveniently from the comfort of your home.

  3. Prescription Drug Coverage: Keep an eye out for changes in prescription drug formularies and pricing. Understanding how your medications are covered under different plans will help you choose the one that best suits your needs and budget.

Private Medically Underwritten PPO Plans: Year-Round Availability

Private Medically Underwritten Preferred Provider Organization (PPO) plans to offer an alternative option for those seeking more personalized healthcare coverage. Unlike traditional plans, medically underwritten PPOs consider your health history and medical conditions when determining coverage and premiums. Here's why these plans are worth considering:

  1. Tailored Coverage: Medically underwritten PPO plans allow for a more personalized approach to healthcare coverage. Your unique medical profile is taken into account, ensuring that you have the coverage you need where it matters most.

  2. Access to Quality Providers: PPO plans often grant you access to a wider network of healthcare providers, giving you the freedom to choose doctors and specialists that align with your preferences.

  3. Year-Round Availability: Unlike the standard open enrollment period, private medically underwritten PPO plans are available throughout the year. This means you have the flexibility to enroll when it's most convenient for you without being restricted to a specific time frame.

Why Work with Licensed Health Advisors or Brokers?

Navigating the world of health insurance can be complex, and making the right choice requires careful consideration of various factors. This is where licensed health advisors or brokers play a crucial role:

  1. Expert Guidance: Licensed advisors possess in-depth knowledge about different plans, coverage options, and recent changes in healthcare regulations. They can help you understand complex terms and make sense of the fine print.

  2. Tailored Recommendations: Advisors take the time to understand your unique healthcare needs, budget, and preferences. With this information, they can recommend plans that align with your individual requirements.

  3. Savings Potential: Advisors can help you identify cost-saving opportunities, such as subsidies or tax credits, that you might not be aware of when shopping for insurance on your own.

Take Action Today with RKA Insurance Advisors

As the 2024 open enrollment season approaches, and even throughout the year, RKA Insurance Advisors is here to guide you through the process of selecting the right healthcare coverage for you and your family. Our team of licensed health advisors is well-equipped to provide you with expert insights, personalized recommendations, and a thorough understanding of private medically underwritten PPO plans.

Visit www.rkainsuranceadvisors.com to learn more about our services and to connect with one of our experienced advisors. Together, we'll ensure that you make informed decisions about your health coverage that align with your unique needs and aspirations. Your health and peace of mind are our top priorities, and we're committed to helping you achieve them every step of the way.

www.RkaInsuranceAdvisors.com

561-806-9913

Info@RKAInsuranceadvisors.com

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Lost Health Insurance?

Lost health insurance? Most people qualify for a Special Enrollment Period. Compare ACA vs. private PPO options, verify your doctors, and start coverage quickly with RKA

Lost Health Insurance? What to Do Next (Step-by-Step) | RKA

Enrollment Guides • Special Enrollment

Lost Health Insurance? What to Do Next

Fast take: Losing coverage is stressful—but you have options. Most people qualify for a Special Enrollment Period (SEP) to enroll in a new plan. We’ll help you compare ACA vs. private PPO options, verify your doctors, and start coverage quickly.

Step 1: Assess your situation

Confirm why and when your coverage ends (job change, hours reduction, divorce, aging off a parent’s plan, etc.). Your reason sets your eligibility window and documentation needs.

Step 2: Talk to a licensed advisor

Health insurance has moving parts—networks, Rx tiers, referrals, and deadlines. A licensed advisor helps you avoid gaps and costly mistakes while matching plans to your providers and budget.

Step 3: Check eligibility for a Special Enrollment Period (SEP)

  • Common QLEs: loss of employer coverage, COBRA ending, move to a new ZIP/state, marriage/divorce, birth/adoption, income changes.
  • Timing: Most SEPs last 60 days from the event. We’ll confirm your exact window and effective date rules.

ACA Marketplace Plans

  • Guaranteed acceptance.
  • Potential income-based subsidies to lower premiums.
  • Networks and deductibles vary—verify your doctors and Rx.

Private Medically Underwritten PPOs

  • Often lower premiums for healthy applicants.
  • Frequent nationwide PPO access—good for travelers.
  • Underwriting applies; we pre-screen and confirm networks first.

Step 4: Consider COBRA vs. switching

COBRA keeps your employer plan temporarily but you pay the full premium (plus admin fee). We’ll run ACA vs. PPO vs. COBRA side-by-side so you can see total annual cost with your expected usage.

Step 5: Budget for healthcare costs

  • Monthly premium and employer/COBRA contribution (if any).
  • Deductible, copays, coinsurance, and maximum out-of-pocket.
  • Prescription costs and prior authorization requirements.

Step 6: Secure new coverage—without gaps

Once we’ve confirmed eligibility and networks, we’ll submit your application, confirm your effective date, and set up online account access and ID cards.

Need help replacing coverage fast?

We’ll confirm your SEP window, verify your doctors and prescriptions, and place coverage quickly so you don’t go uncovered.

Quick FAQs

Will I have a gap between plans?
Not if we align your application date with cutoff rules. Marketplace coverage often begins the 1st of the next month; some PPOs offer 1st or 15th start dates.
Can I switch off COBRA later?
Yes. You can switch during Open Enrollment or if another qualifying event occurs. We’ll time the change to avoid gaps.
Can you verify my doctors before I enroll?
Absolutely. Send your provider list (names & locations) and prescriptions—we’ll verify network participation and Rx tiers first.

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

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Why Health Insurance Matters

At RKA Insurance Advisors, we understand the significance of safeguarding your health and well-being. We proudly offer free health insurance quotes for individuals, families, self-employed professionals, and small business owners. In this blog, we'll explore the critical importance of having health insurance coverage and how our tailored plans ensure affordability and security for you and your loved ones.

Why Health Insurance Matters:

  1. Protecting Your Health: Health insurance provides a safety net for unexpected medical expenses, ensuring you have access to quality healthcare when needed. It covers doctor visits, hospitalization, prescription medications, and preventive care, promoting early detection and better health outcomes.

  2. Financial Security: Medical emergencies can be financially crippling, but with health insurance, you can avoid the burden of high medical bills. Having coverage means you can focus on recovery rather than worrying about healthcare costs.

  3. Coverage for Loved Ones: Health insurance plans for families extend protection to your loved ones, offering peace of mind knowing that their health needs are taken care of. You can rest assured that your family's well-being is a top priority.

  4. Accessible and Affordable: Our health insurance quotes cater to individuals, self-employed professionals, and small business owners' specific needs. We offer customizable plans that fit your budget and provide access to a broad network of healthcare providers.

  5. Coverage Outside of Open Enrollment: Plans are available year-round if you are outside of open enrollment, offering flexibility and options to secure coverage regardless of the time of year.

Affordability Based on Health:

We understand that one size does not fit all regarding health insurance. Some plans consider your health conditions and can be medically underwritten, potentially leading to more affordable premiums based on your health profile. This way, you can receive comprehensive coverage without compromising your budget.

Please don't wait for life's uncertainties to take their toll. Secure your health and your future today with our free health insurance quotes. Click the link below to explore our plans and discover the peace of mind that comes with comprehensive health coverage:

CLICK TO CALL

OR

BOOK AN APPOINTMENT

At RKA Insurance Advisors, we believe that everyone deserves access to quality health insurance. Our tailored plans for self-employed professionals, small business owners, individuals, and families provide the coverage you need at an affordable price. Take the proactive step towards safeguarding your health and future by contacting us for a free health insurance quote today.

For inquiries or to get started, contact us at INFO@RKAINSURANCEADVISORS.COM or visit our website at WWW.RKAINSURANCEADVISORS.COM. Our team of dedicated advisors is ready to assist you in finding the perfect health insurance plan for your needs.

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Truckers Health Insurance (2025–2026): Owner-Operators & CDL Drivers Guide | RKA

Truckers need coverage that works in every state they drive. We compare ACA vs. private PPOs, verify doctors along your routes, model subsidies for variable income, and set up telehealth/Rx for life on the road.

Truckers Health Insurance (2025–2026): Owner-Operators & CDL Drivers Guide | RKA

Guide • Owner-Operators & CDL

Truckers Health Insurance (2025–2026): Simple, Road-Ready Options

Fast take: Trucking life crosses state lines—your coverage should too. We compare ACA Marketplace options (often with subsidies) against private, medically underwritten PPOs for eligible drivers, then confirm your doctors, pharmacies, and hospitals along the routes you actually run.

Need coverage that works in every state you drive?

We’ll estimate subsidies, check nationwide PPO access, verify your doctors, and show total annual cost—no pressure, just answers.

Your main paths

1) ACA Marketplace (with possible subsidies)

  • Pro: Guaranteed issue, tax credits can lower premiums.
  • Watch: Networks can be local—confirm out-of-area rules for multi-state routes.
  • Best for: Drivers with variable income who likely qualify for credits.

2) Private, medically underwritten PPO

  • Pro: Broad nationwide PPO access; may beat unsubsidized ACA pricing for healthy drivers.
  • Watch: Health underwriting applies; we pre-screen quickly.
  • Best for: Owner-operators who want consistent nationwide networks and predictable costs.

Road-ready tips

  • Check your lanes: Tell us your common routes—TX-FL, I-10, I-80—so we verify in-network care along the way.
  • Telehealth first: Virtual visits cut downtime between loads; many plans include 24/7 telemedicine.
  • Rx strategy: Confirm formulary tiers and use nationwide pharmacy chains for easy refills.
  • HSA play: With an HSA-eligible plan, contributions may reduce taxes and cover on-the-road expenses.
  • OccAcc ≠ Health: Occupational accident is useful but does not replace major medical coverage.

How RKA helps truckers

  • Nationwide network checks: We confirm providers where you drive—not just near your home base.
  • Subsidy modeling: We map variable income by quarter to estimate credits accurately.
  • Fast enrollment: Avoid gaps between contracts; coordinate effective dates with dispatch schedules.

Ready for a side-by-side built for the road?

ACA vs PPO, doctors verified, Rx checked, total cost projected—so you can keep rolling.

Quick FAQs for Truckers

Will my plan cover me in other states?
It depends on the plan. Some PPOs have national networks; many HMO/EPO plans limit out-of-area coverage. We’ll confirm along your routes.
Can I switch outside Open Enrollment?
Private PPOs may be available year-round if you qualify. ACA plans require Open Enrollment or a qualifying life event.
Do telehealth visits count as in-network?
Usually yes with participating vendors—great for quick care between loads.
Can I use an HSA as an owner-operator?
Yes, with an HSA-eligible plan. Contributions may reduce taxable income; funds roll over year to year.

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

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Millions of people who rely on Medicaid could lose eligibility & be without coverage.

Millions of people who rely on Medicaid could lose eligibility & be without coverage.

Coverage Update

Millions Who Rely on Medicaid Could Lose Coverage — What to Do Next

Updated Oct 15 • Written by Robert Adams

Fast take: Millions of Americans are projected to lose Medicaid coverage as federal funding and eligibility provisions unwind. If this impacts you, act quickly—many qualify for a Special Enrollment Period to transition into new coverage and avoid a lapse.

Need Help Choosing the Best Plan in Your ZIP?

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

Get Free Quotes Book a Call

What’s Happening

During the pandemic, Medicaid programs expanded eligibility and paused re-verification to keep people covered. Those emergency measures are now ending. States are re-checking eligibility, and many Americans are finding their Medicaid coverage is being terminated—even if their income hasn’t changed drastically.

At RKA Insurance Advisors, we understand the confusion this creates. We help individuals and families review options fast to avoid any coverage gaps—whether through the Marketplace or an underwritten private PPO plan that offers nationwide access and flexibility.

What You Can Do Right Now

Once you lose Medicaid, you trigger a 60-day Special Enrollment Period (SEP). This is your limited window to enroll in a new plan and keep continuous coverage.

  • Marketplace (ACA) Plans: You may qualify for premium tax credits or cost-sharing reductions based on income.
  • Private PPO Plans: Medically underwritten plans may provide broader networks and lower deductibles for qualified applicants.
  • COBRA: If you recently left an employer plan, COBRA continuation may still be available as a bridge option.

When Coverage Starts

  • Enroll by the 15th: Coverage typically starts the 1st of the next month.
  • Enroll after the 15th: Coverage usually starts the 1st of the following month.
  • Bring Documentation: Keep your Medicaid termination letter—it’s required proof for a Marketplace SEP.

How to Protect Your Wallet

  1. Start your SEP immediately. Waiting even a few weeks can delay your effective date and leave you uninsured.
  2. Compare your total annual cost. Don’t just look at the premium—factor in deductibles, copays, and max out-of-pocket.
  3. Check providers and prescriptions first. Confirm your doctors and medications are in-network before you switch.
  4. Consider PPO flexibility. If you travel or need out-of-state care, Private PPOs often provide better nationwide access.

Not Sure Which Option Fits Your Family?

We’ll compare ACA vs. Private PPOs with your doctors and medications in mind and show clear, side-by-side costs—so you can decide confidently.

Get Free Quotes Book a Call

Quick FAQs

Will I be uninsured right away if I lose Medicaid?

No. If you act quickly, you can transition directly into Marketplace or Private PPO coverage without a lapse.

Can I get premium help?

Yes. Marketplace plans often include tax credits that lower your monthly premium based on income.

What documents do I need?

Keep your Medicaid termination or eligibility notice. It’s required to confirm your Special Enrollment eligibility.

Can I switch plans later?

After your SEP ends, you typically need to wait for Open Enrollment or another qualifying life event to change coverage.


Robert Adams • President & Licensed Agent • NPN 19540130

Licensed in AL, CO, DE, FL, GA, IA, IL, IN, KY, KS, LA, MD, MI, MO, MS, MT, NC, NE, NV, OH, OK, SC, SD, TN, TX, UT, VA, WI, WV, WY

For education only; availability and benefits vary by carrier and state.

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Time is Running Out: The Open Enrollment Deadline for Health Insurance Quotes is December 15th!

Take advantage of your chance to secure health insurance quotes for the upcoming year. The Open Enrollment Deadline for 2023 is quickly approaching, and time is running out. December 15 marks the last day individuals and families can apply for or renew their existing health insurance plans to start January 1st. So don't delay - take advantage of this window of opportunity to make sure you have the coverage you need for the coming year.

How do I know if I'm eligible for a subsidy?

During the Open Enrollment period, which runs from November 1 to January 15 each year, individuals and families can shop for, compare, and purchase health insurance coverage. Small business owners and the self-employed also have the opportunity to find quality coverage during this time. December 15 is the cut-off for a plan to start January 1st. 

Speaking to a licensed health coverage advisor, you can get an estimate of your costs and premiums and see how much you could save on a qualified health plan. The amount of savings you may qualify for depends on your income level, the size of your family, and the type of coverage you select. Five out of six people generally qualify for savings when purchasing a health plan. In addition, you can compare and check eligibilty for medically underwritten private plans not available on the marketplace exchange.

Don't wait to take advantage of Open Enrollment! Make sure to speak to a licensed advisor who can compare all your coverage choices. Doing so will help ensure you get the coverage you need at an affordable rate. For example, suppose you're eligible for a subsidy and don't get health insurance quotes by the Open Enrollment deadline of January 15. In that case, you may have to wait until the next Open Enrollment period to get a plan at a discounted rate. Especially if you are not eligible for medically approved coverage options, so take advantage of the chance to save on family and individual health insurance or small business and self-employed health insurance coverage. Get your health insurance quotes now and take advantage of affordable plans before it's too late.

How do I enroll in a health insurance plan?

When enrolling in a health insurance plan, it's vital to ensure you are getting the best coverage for your needs and budget. One of the best resources you can use to help you choose the right plan is a Licensed health coverage advisor. They can provide personalized advice, guidance, and information about the plans available and what will work best for your situation. 

In addition, you can also utilize an online enrollment platform to get instant quotes from multiple insurers. This will help you compare rates and features between the various plans to choose the best fit your requirements. Online quote comparisons do not consider or compare medically underwritten plans. These plans must be provided by a licensed advisor. Rates can be, at times, 20-30% more affordable than marketplace plans if you do not qualify for substantial savings. Don't miss out on this important opportunity - December 15 is the Open Enrollment Deadline for coverage to begin January 2023. Act now to secure your health insurance coverage for the coming year.

Reach out to us today to ensure you have the best coverage at the most affordable rate! 

WWW.RKAINSURANCEADVISORS.COM

561-806-9913

INFO@RKAINSURANCEADVISORS.COM

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IMPORTANT OPEN-ENROLLMENT INFO AND DEADLINES

Important Open-Enrollment Information

With Open Enrollment well underway, which started November 1st, 2022. Some important & key dates to be made aware of. The Federal Open Enrollment Period runs from November 1, 2022, through January 15, 2023, for health insurance coverage beginning in 2023. To get coverage starting January 1, 2023, you MUST sign up by December 15, 2022

When does the Open Enrollment Period end?

The OEP for the federal exchange ends on January 15, 2023. With plans to start February 1, 2023, if enrolled between December 16 to January 15.

What are the exceptions to Open Enrollment?

Unless you experience a qualifying life event, the Open Enrollment Period is the only time you can enroll in health insurance plans. Suppose you suddenly lose health care coverage due to divorce, moving primary living to a different zip code, childbirth, or any other significant changes in your life. In that case, however, you may be qualified to enroll in a health plan during a Special Enrollment Period. A Special Enrollment Period will allow you to get health insurance for up to 60 days after a qualifying event for the remainder of the year. However, remember that you will not qualify for a Special Enrollment Period if you lose coverage because of failure to pay insurance premiums.

Is there an Open Enrollment for dental insurance?

There is no Open Enrollment for other insurance products, such as dental and vision. 

Can I make a change to my marketplace plan outside of Open Enrollment?

No, you can't change your marketplace plan outside of Open Enrollment. However, you may need health insurance outside the Open Enrollment Period or are unsatisfied with your current health coverage selection. In that case, you may qualify for private health-based, medically underwritten plans that are available year-round. These plans, due to the healthier risk pool, rates usually are more affordable than the marketplace if you do not qualify for a subsidy. Also, there are select guaranteed-issued plans available outside of open enrollment. These options are limited. 

What do I do if I have questions or need help picking a plan?

That's exactly where we step in. Our team of specialists are licensed in 32 states. Our primary job is to advise, educate and help pick a plan that will work best for you, your family, or your small business. Your health coverage will significantly impact your overall healthcare experience, so it's an important decision. 

CONTACT US TODAY FOR QUOTES, QUESTIONS, COMPARE PLANS, OR ENROLLMENT ASSISTANCE 

INFO@RKAINSURANCEADVISORS.COM

561-806-9913 

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OPEN ENROLLMENT IS HERE

Open Enrollment 2023

THE 2023 OPEN ENROLLMENT PERIOD FOR ACA/MARKETPLACE PLANS HAS ARRIVED!

This is the time of year you can check eligibility & savings, compare plans, view newly released plans, and enroll in health coverage. If you make under 30k, you could be eligible for plans as low as 0 dollars a month. The marketplace is a great option for securing health coverage as you cannot be denied the right to coverage based on medical conditions.

The marketplace is not your only place to shop for affordable health coverage, as private, medically underwritten plans are also available. Knowing which plans are best for you, what type of network, how much your deductible and max out-of-pocket should be, which insurance carrier you should choose, and do my doctors accept this plan are all questions were can assist in answering.

At RKA Insurance Advisors, these are the exact things we specialize in. We pride ourselves on making sure we first advise and educate, so you can select the best plan for you in the event the worst happens. Your medical coverage can significantly impact your healthcare experience, so it’s an important decision. You don’t have to make it alone. Contact us today!

https://www.rkainsuranceadvisors.com/book-an-appointment-1

561-806-9913

Info@RKAinsuranceadvisors.com

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Can you afford to NOT have health coverage?

Can you afford to NOT have Health Coverage?

For the uninsured and mostly healthy individuals who feel the added monthly cost of health insurance is not worth it. We understand how you may feel that way. Paying for something you don’t use or rarely use doesn't make sense to most people, and it's hard to justify the cost. 

There is a vast misconception regarding the purpose of health insurance. Of course, we want it to cover our day-to-day needs. Doctor visits, yearly wellness check-ups, and prescriptions, especially if I’m paying a monthly premium. Many plans do, but not all. So the frustration people have when they do not use their insurance often, then the one time they do, they have a copay, a deductible, or something not covered can, of course, lead to frustration. This is more a lack of understanding, not just about the purpose of health insurance but an overall understanding of your current insurance plan and how to use it. 

Having a licensed advisor to help you navigate to pick a plan that not only covers the day-to-day but covers the large claims is the best way to go. Let's say for a moment you didnt use a licensed advisor, and you went to the marketplace and picked the cheapest plan. In that situation, more than likely, you'll be paying out of pocket for most medical claims other than annual wellness. So we understand the frustration and apprehension to even having health coverage.

This leads to the primary purpose of this topic. Health coverage is intended to cover major things. There are deductibles, Co-insurance, and Max out of pocket, which are the insured's responsibility. But let's look at the avg cost of some medical services. 

  • Surgical treatment of a broken arm $16,000.00 +

  • Surgical treatment of a broken leg $ $17,000 to $35,000

  • Non-Surgical Broke Nose realignment $2,000 to $5,000

These services, of course, are not including the cost of:

  • X-Rays provide a two-dimensional picture of the broken bone

  • Bone scans are used when fractures don't show on an X-Ray

  • CT Scans use computers to show detailed slides of broken bones

  • MRIs create a very clear image using a magnetic field

These services can cost thousands in themselves. Also, they aren't considered major medical or catastrophic claims. However, let's examine the cost of some unexpected catastrophic claims.

The average cost of a less severe heart attack is $760,000. And if you spread those figures out over 20 years of payments, that's $38,000 per year for a less severe heart attack. 

Managing heart disease can cost upwards of $20,000 a year

Now ask yourself, would you rather have $38,000 in medical bills annually over the next 20 years? Or would you prefer a minor monthly premium to cover most of this cost? 

Let's take a look at some other conditions:

People who have cancer can quickly amass six-figure medical bills. In 2018, AARP reported average cancer treatment costs of around $150,000.

Now ask yourself, would you rather have this medical bill or a small monthly premium to cover most of this cost? 

  • Heart Valve Replacement: $170,000

  • Heart Bypass: $123,000

  • Kidney Transplantation: $87,538 and $124,271

  • Disc Replacement Surgery: $16,700 – $45,800

  • Spinal Fusion Cost Average: $15,700 – $94,300

  • Gallbladder surgery: $54,041

Now ask yourself, would you rather have this medical bill or a small monthly premium to cover most of this cost? 

These are just some of the many conditions & treatments Americans face daily. Insurance is not going to cover all of this at 100%. It is NOT a credit card. There is a portion you would be responsible for. Mostly, that is to help offset claim loss & to keep rates reasonability affordable. We understand that word affordable can be subjective. 

Let's say you have an insurance plan; you pay 300.00/ month for the last year. You have a $5,000 deductible with a max out-of-pocket of $7,000. You then have a heart attack. The claims start to pile in, and the above figure of $760,000 is the final bill. 

The current example plan will pay 753,000 of the cost in that instance. Leaving you with your responsibility of the max out-of-pocket of $7,000. If you want to calculate the cost of the 12-month premium, that still would only be $10,600 compared to $760,000. It seems like a pretty fair deal, right? Even the scaling across 20 years of $38,000. This is a much better alternative than being uninsured.

This is precisely the primary purpose of health insurance—to cover major claims.

Coincidentally, why 2/3 of all bankruptcies are medically related, so it’s very important to have a full coverage insurance plan that makes sure you’re in the best position in the event the worst happens.

Hopefully, we have put some things in perspective for you as to why it's essential to have health coverage. Not just why it's important to have but also to understand your current health plan. With the upcoming open-enrollment season, it's a perfect time to speak to a licensed health advisor to review your current plan, check newly released plans, make sure you know how it works, or receive quotes for a new plan if you do not have one. We look forward to hearing from you! 

WWW.RKAINSURANCEADVISORS.COM

561-806-9913

INFO@RKAINSURANCEADVISORS.COM

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Benefits of Telemedicine

Benefits of Telemedicine

Telemedicine, which enables video or phone appointments between patients and their health care providers, benefits both health and convenience. As technology advances, telemedicine will continue to become more popular as more health care providers offer to "see" patients by computer and smartphone.

There was a growing trend pre-Covid-19 of telemedicine, also known as Telehealth. However, since early 2020 when the spread of Covid-19 was at its peak, health care providers have rapidly implemented this virtual service into their practice for safety and to continue serving and treating patients. In addition, there are many vital aspects and benefits telemedicine offers that traditional in-person visits cannot offer.

Convenience

With telemedicine, you don't have to drive to the doctor's office & sit in a waiting room when you're sick for an hour before seeing a doctor. Instead, you can see your doctor from the comfort of your home.

Virtual visits are much easier to fit into your busy schedule. With telemedicine, most often, a quick refill of a routine medication can be done from the comfort of your house or workplace. 

Mitigate the spread of Illness 

To help prevent the spread of infectious diseases and other illnesses, doctors can use telehealth appointments to prescreen patients for possible contagious diseases. Less exposure to other germs helps everyone, especially chronically ill, pregnant, elderly, or immunocompromised.

Primary Care and Chronic Condition Management

Regular visits with primary care practitioners, such as those specializing in family medicine, internal medicine, and pediatrics, are essential to your family's health. Telemedicine makes it easy to connect with a doctor or nurse practitioner. In addition, some platforms and providers are available 24/7. 

Cost

Telemedicine collectively can decrease costs not only for the overall healthcare system but for the patient specifically. Most insurance plans cover telemedicine visits at 100% without having to satisfy a deductible. Claims to insurance companies for these visits tend to be less than an in-person visit as well. When telemedicine is used as opposed to utilizing your local ER as a PCP when you have a non-emergency medical event, this alone can decrease overall health care and coverage costs. Most importantly cost you less. Most cash-pay telemedicine visits cost less than an actual in-person doctor's visit. 

Doctors can treat more Patients

Telemedicine provides alot of flexibility to both patients and healthcare providers. This flexibility allows providers to see patients after hours. Thus, opening healthcare providers to treat more patients more frequently and faster. Most telemedicine can be completed within 15 minutes. 

Implementing telemedicine in our healthcare system can drastically improve medical outcomes, drastically reducing patient and healthcare costs. If you are uncertain if your current coverage has telemedicine service, reach out to us so we can review your plan benefits. With the open-enrollment period for 2023 fast approaching, now is the perfect time to speak to one of our licensed advisors to review your current coverage or get quotes. Options can be tailored to your specific situation, preferences, and budget. We aim to not only provide you with flexible options but to advise and educate you in today's market.

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