When is Open Enrollment for individual health insurance?

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

What if I miss Open Enrollment?

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

Can I enroll in a private PPO outside Open Enrollment?

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

When does my new plan start?

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

Why shouldn’t I go solo during Open Enrollment?

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

How can a licensed advisor save me money?

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

When are the Open Enrollment 2025 deadlines?

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

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

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

Do PPOs always have nationwide access?

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

Will an HMO cover me when I travel?

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

What is prior authorization?

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

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

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

Who will be most affected by this change?

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

What are my alternatives to short-term plans?

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

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

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

Which is better for small, multi-state teams?

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

Will a PPO always be more expensive?

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

What income counts for ACA subsidy eligibility?

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

How do I avoid paying back subsidies at tax time?

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

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

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

What if I underestimated income?

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

Do life changes affect subsidies?

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

What is the difference between PPO and HMO for frequent travelers?

PPO plans offer broader, often nationwide networks and do not typically require referrals, making them more flexible on the road. HMOs tend to be regional and require PCP referrals; out-of-area care is usually limited to emergencies.

I lost my job and coverage—what’s my timeline?

Most people get a 60-day Special Enrollment Period (SEP) from the date of coverage loss to enroll in a new plan. COBRA election windows may differ.

Is COBRA my only option?

No. You can compare ACA Marketplace plans (with potential subsidies) and, if eligible, private medically underwritten PPOs. We’ll verify doctors and costs for each path.

Can I start coverage mid-month?

Marketplace plans typically start the 1st of the following month if you apply by the cutoff. Some private PPOs allow 1st or 15th starts after approval.

What health insurance options work best for truckers?

Two common paths are ACA Marketplace plans (with potential subsidies) and private medically underwritten PPOs for eligible drivers. Choice depends on income, travel, and provider access needs.

Can I keep nationwide PPO access while on the road?

Yes. Some private PPO options include broad national networks. We confirm your key doctors and hospitals before enrollment.

Do owner-operators qualify for subsidies?

Many do. Subsidies are based on household size and estimated Modified Adjusted Gross Income (MAGI). We help model variable income to estimate credits correctly.

Are HSAs good for truckers?

If you choose an HSA-eligible plan, contributions may reduce taxable income and build a reserve for medical expenses while on the road.

Is occupational accident the same as health insurance?

No. OccAcc can cover work-related injuries for owner-operators but it is not major medical. Most drivers still need comprehensive health insurance for everyday care.

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

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

Open Enrollment is here! Learn key 2026 health insurance deadlines, who qualifies for Special Enrollment, and how to compare ACA vs private PPO plans before the window closes

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

Guide • Open Enrollment

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

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

Key windows at a glance

Open Enrollment (most states)

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

Special Enrollment (life events)

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

Income-based SEP (some situations)

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

Private PPO (if eligible)

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

How to avoid missing your window

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

Quick FAQs

Do state-based Marketplace dates differ?

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

Can I switch plans mid-year?

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

Are private PPOs available in my state?

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

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

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

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

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

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

Enrollment Guides • Open Enrollment 2025

Open Enrollment 2025: The Hidden Costs of Doing It Alone

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

Why working with an advisor matters

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

Key benefits of guidance

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

How a licensed advisor may save you money

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

Quick steps to start enrollment with confidence

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

Nov 1: Open Enrollment begins.

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

Preparing for Open Enrollment 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.

Get Free Quotes Book a Call

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.

Get Free Quotes Book a Call

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.

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

Understanding Insurance Networks: A Key Component of Your Health Coverage

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

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

Guide • Networks & Access

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

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

The four common network types

HMO — “Stay in the circle”

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

PPO — “More flexibility”

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

EPO — “HMO-like, no referrals”

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

POS — “Hybrid”

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

Key rules to check before you enroll

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

Which network should I choose?

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

Quick FAQs

Are urgent care visits covered out of network?

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

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

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

Can I change networks mid-year?

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

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

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

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

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

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

Health Insurance Updates • Policy Change

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

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

Why the new rules put many at risk

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

Your alternatives: Marketplace vs. underwritten plans

ACA Marketplace Plans

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

Medically Underwritten Plans

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

Employer Coverage

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

Secure your coverage today

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

Quick FAQs

When does the new rule take effect?

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

Can short-term plans still be useful?

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

How can RKA help?

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

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

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

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

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

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

Small Business • Networks & Access

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

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

What is an insurance network—and why it matters

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

PPO — flexibility & broader access

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

HMO — tight networks & coordinated care

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

PPO vs. HMO: cost, flexibility, and coverage

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

Why a licensed advisor makes a difference

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

Risks of going it alone

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

Quick FAQs

Is a PPO always the safer choice?

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

Do HMOs ever cover out-of-network care?

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

How do we verify our doctors?

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

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

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

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

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

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

Guides • Taxes & Reporting

Avoid Tax Penalties: Navigating Health-Insurance Income Reporting

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

MAGI 101: What actually counts

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

Update income at the right times

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

A simple, low-stress workflow

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

Self-employed tips

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

Quick FAQs

What if I overestimated income?

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

Do I need to report small fluctuations?

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

Can you update my application for me?

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

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

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

Traveler-Friendly Health Insurance: Stay Covered Wherever You Go

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

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

Travel Health Coverage

Traveler‑Friendly Health Insurance: Stay Covered Wherever You Go

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

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

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

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

Why traveler‑friendly health insurance?

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

Key features frequent travelers value

1) Nationwide provider access

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

2) Emergency & urgent care coverage on the road

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

3) Help coordinating care

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

4) Options for international travel

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

How RKA Insurance Advisors helps

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

Get Quotes Now Book an Appointment

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

Traveler FAQs

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

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

Do I need separate travel medical insurance for international trips?

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

What’s better for travelers: PPO or HMO?

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

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

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

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

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

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

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

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.

Get Free Quotes Book a Call

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.

Compare Your Options Talk to an Advisor

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

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

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.

Get Free Quotes Book a Call

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)

Gather quick proof: business/1099 income docs; prior coverage details if switching.
List providers & meds: the doctors/hospitals you want to keep; current prescriptions (name + dosage).
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.

Get Free Quotes Book a Call

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

Robert Adams 10/15/23 Robert Adams 10/15/23

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.

Get Free Quotes Book a Call

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

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

Robert Adams 9/14/23 Robert Adams 9/14/23

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.

Get Free Quotes Book a Call

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 • 561-806-9913 • robert@rkainsuranceadvisors.com

Robert Adams 8/29/23 Robert Adams 8/29/23

2026 Open Enrollment Changes: What’s New, What’s Driving Cost, and What to Do Now

Major 2026 Open Enrollment updates: Premiums up, out-of-pocket limits higher, and subsidy extensions uncertain. Compare Marketplace vs Private PPOs before it’s too late.

Enrollment Help • Nov 5 • Written by Robert Adams

2026 Open Enrollment Changes: What’s New, What’s Driving Cost, and What to Do Now

Fast take:

The 2026 open enrollment is bringing significant shifts — premium hikes, higher out-of-pocket caps, and subsidy uncertainty all combine to change the game from previous years. If you’re qualifying for coverage for 2026, it’s time to compare [Marketplace](chatgpt://generic-entity?number=0) vs. private medically-underwritten PPOs vs. COBRA exit strategies and pick your right window **before the clock runs out**.

Marketplace (Government)

• Premium filings show increases for 2026 in many states.
• Max out-of-pocket limits are rising — you may pay more if you use care.
• Subsidy changes are unconfirmed — if enhanced credits fade, your “net” cost could jump.

Private PPO (Licensed Access)

• Not tied to federal subsidy legislation — pricing is independent.
• Often broader PPO networks and fewer referral restrictions.
• Eligibility required, but it’s a powerful option when Marketplace costs spike.

What’s new for 2026 open enrollment

The landscape has shifted in part due to macro-factors and in part due to policy. Here’s what’s driving the changes:

Carrier cost-trend is higher → claims, drugs, and specialty care all escalate and carriers file accordingly.
Higher out-of-pocket maximums → The yearly cap is creeping up again, meaning more financial risk for members.
Subsidy uncertainty → If enhanced credits aren’t extended or phase down, even a stable income could leave you paying more.
COBRA exposure remains extreme → If you’re losing employer coverage, staying on COBRA might cost more than shopping alternatives now.

What this means for you and your family

For example: a 45-year-old couple with two children saw a typical Bronze Marketplace renewal jump from $1,250 / mo in 2025 to around $1,650 / mo in 2026. The max out-of-pocket climbed from $8,700 to $10,000. That means:

• You’ll pay a higher premium just to stay in the same segment.
• If you or a family member use care early in the year, you’ll hit higher OOP sooner.
• If subsidies are reduced, your net cost could rise again — even if your plan looked okay today.

That’s why we tell households: don’t renew blind. Compare Marketplace vs Private PPO vs COBRA alternative to see your real cost before you lock in.

What to do next: Your 3-step checklist

1) Submit your details

ZIP, ages, income estimate — so we can test all paths for you.

2) Verify your doctors & prescriptions

Network changes in 2026 are real. Let us check before you pick a plan.

3) Compare your three paths

Marketplace vs Private PPO vs COBRA exit — pick the one that fits your risk-level and timing.

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

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

Get Free Quotes Book a Call

Quick FAQs

Will I automatically see higher 2026-costs if I stayed in the same plan?

Often yes — even if your benefits didn’t change. Because premiums and OOP maximums are rising across the board.

What if enhanced subsidies get extended again?

Great if they are — but don’t bet on it. We prepare your plan assuming worst-case and then re-run if credits improve.

Can I switch mid-year if I pick wrong?

Maybe — but limited. That’s why we use a licensed advisor to match your timing, plan, and risk exposure before you enroll.

Robert Adams

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

Robert Adams 8/4/23 Robert Adams 8/4/23

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.

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.

Robert Adams 8/2/23 Robert Adams 8/2/23

Why Health Insurance Matters in 2026: Protection & Costs

Staying uninsured is risky. A single ER visit or surgery can create years of debt. The right health plan protects your health, your family, and your wallet by covering everyday care and unexpected emergencies.

Why Health Insurance Matters

Staying uninsured is risky. A single ER visit, surgery, or specialty medication can create years of debt. The right health plan protects your health, your family, and your wallet—before and after something serious happens.

Think of health insurance as a financial safety system: it keeps everyday care affordable, caps your worst-case bills in a bad year, and gives your family more stability when life changes unexpectedly.

Everyday care that stays affordable

Helps with sick visits, labs, imaging, and prescriptions.
Uses copays or in-network discounts instead of full price.
Makes preventive care easier to keep up with.

Protection from “worst-case” bills

Turns unpredictable hospital bills into capped costs.
Uses deductibles and out-of-pocket maximums to limit damage.
Helps you avoid long-term medical debt after an emergency.

Financial stability for your family

Reduces the chance a surprise bill blows up your savings.
Helps protect your credit and long-term goals.
Gives you more control over how you budget for health care.

What tends to cost more—and why

Staying uninsured

You pay full retail cost for ER visits, imaging, and surgery.
Hospitals can bill tens of thousands of dollars for a single event.
No out-of-pocket maximum to cap how bad a year can get.

Having the wrong-fit plan

Too-high deductible or out-of-pocket max for your budget.
Networks that don’t include your main doctors or hospitals.
Drug coverage that doesn’t line up with your medications.

How to decide in minutes

Stay the course if…

Your current plan is affordable and covers your doctors and meds.
You’ve already met your deductible and have upcoming care.
You understand your out-of-pocket max and it fits your savings.

Review options with RKA if…

Your premiums jumped or you’re worried about 2026 increases.
You’re not sure if ACA Marketplace or private PPO fits better.
You want someone to verify doctors, hospitals, and medications for you.

Our role is to remove the guesswork. We map out what you actually use—doctors, prescriptions, budget—and then show how different plan types handle those needs.

Want a plan that actually fits your life?

We’ll verify your doctors and prescriptions, compare ACA Marketplace and private PPO options in your ZIP, and show clear costs—no pressure, just answers.

Get Free Quotes Book a Call

FAQ

Do I really need health insurance if I’m young and healthy?

Yes. Insurance is designed for the unexpected—accidents, new diagnoses, or sudden surgeries. When you’re healthy, you still benefit from low-cost preventive care and protection if something changes.

What’s the biggest risk of going without coverage?

One major event—such as an ER visit, imaging, or a short hospital stay—can create bills that take years to pay off. Without a plan, there’s no out-of-pocket maximum to cap how bad the year can get.

How do ACA Marketplace plans and private PPOs fit into this?

Marketplace plans use income-based credits and standardized benefits. Private PPOs can offer $0 deductibles, nationwide networks, and different pricing for healthy households. We compare both side-by-side so you’re not guessing.

What does it cost to work with RKA Insurance Advisors?

There is no extra cost to you. We’re paid by the carriers, so you get expert guidance and support with the same or better pricing than going direct—plus help during enrollment and if issues pop up later.

This overview is educational, not tax or legal advice. Availability and eligibility vary by state and carrier. Benefits, networks, and pricing are subject to change. Always review official plan documents before enrolling.

Robert Adams 7/22/23 Robert Adams 7/22/23

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.

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.

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.

Robert Adams 3/7/23 Robert Adams 3/7/23

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

Start your SEP immediately. Waiting even a few weeks can delay your effective date and leave you uninsured.
Compare your total annual cost. Don’t just look at the premium—factor in deductibles, copays, and max out-of-pocket.
Check providers and prescriptions first. Confirm your doctors and medications are in-network before you switch.
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.

Robert Adams 12/11/22 Robert Adams 12/11/22

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

Open Enrollment 2026: Enroll by Dec 15 for Jan 1 or by Jan 15 for Feb 1. We’ll compare Marketplace vs Private PPO and verify your doctors first.

Open Enrollment • 2026 Deadlines • Written by Robert Adams

Open Enrollment 2026: Last Day for Jan 1 Coverage Is Dec 15 — Don’t Miss It

The 2026 window runs Nov 1 → Jan 15. Enroll by Dec 15 for a Jan 1 start, or by Jan 15 for a Feb 1 start. Prices are up in many ZIPs, so compare Marketplace vs. Private PPO (if eligible) before you lock in the wrong plan.

Key 2026 dates

Nov 1: Open Enrollment starts.
Dec 15: Deadline for Jan 1 coverage.
Jan 15: Final day to enroll for a Feb 1 start.

Am I eligible for savings?

Most households qualify for some level of credit on Marketplace plans based on income, household size, and ZIP. We’ll run the numbers and show your net premium—then compare against a private, medically underwritten PPO if you’re eligible (often lower premiums for healthy applicants).

Marketplace (Government)

• Can be cheapest if you qualify for credits.
• Many plans are HMO/EPO; referrals are common.
• Credits reconcile at tax time.
• County/ZiP options vary, networks differ.

Private PPO (Licensed Access)

• Often no referrals; broader networks.
• Pricing isn’t tied to ACA credits.
• Great fit when keeping doctors/hospitals matters most.

What to do right now (5 minutes)

1) Send basics

ZIP, ages, household/income range.

2) List doctors & meds

We verify networks + prescriptions.

3) Compare 3 paths

Marketplace • Private PPO • COBRA exit if needed.

Beat the Dec 15 cutoff for Jan 1 start.

We’ll show your net premium with credits, verify your doctors, and stack it against a Private PPO if you’re eligible.

Get Free Quotes Book a Call

Quick FAQs

What happens if I miss Dec 15?

You can still enroll by Jan 15 for a Feb 1 start. After that, you’ll need a Qualifying Life Event—or see if a Private PPO is available.

Will my doctors be in network?

We verify your providers and prescriptions for both paths before you enroll.

Are Private PPOs cheaper?

For healthy households that qualify, they can be competitive vs. unsubsidized Marketplace plans. We’ll show both.

Robert Adams

RKA Insurance Advisors • 561-806-9913 • robert@rkainsuranceadvisors.com

Robert Adams 11/17/22 Robert Adams 11/17/22

IMPORTANT OPEN-ENROLLMENT INFO AND DEADLINES

Open Enrollment only comes once a year—and missing a deadline can lock you into the wrong plan or higher premiums for all of 2026. Here’s a clear breakdown of the dates, what changes, and how we compare Marketplace vs private PPO options with your doctors and meds.

Enrollment Help • Open Enrollment 2026

Written by Robert Adams

Important Open Enrollment Info & Deadlines

Open Enrollment is your once-a-year chance to update, compare, or switch your health insurance. Deadlines, changes in income, or network shifts can impact your premium and benefits. Here is what you need to know to avoid unexpected costs or gaps in coverage.

Key Deadlines for Open Enrollment 2026

Open Enrollment Start

Starts November 1st
Best time to compare plans before rates increase

First Major Deadline

December 15th
Last day for January 1st start

Final Open Enrollment Deadline

January 15th
Last chance to change or enroll until 2027 (unless SEP applies)

Why These Dates Matter

Plans and premiums change every year.
Your income may push you into a new tax-credit bracket.
Networks, deductibles, and prescriptions may shift.
If you do nothing, you may auto-renew into a more expensive or worse plan.

Marketplace vs Private PPO: What to Review

Marketplace Changes (ACA)

New premiums updated yearly
Tax-credit amounts may shift
Many plans are HMO/EPO only
Doctor networks change frequently

Private PPO Updates

Nationwide PPO access
No referrals required
Premiums based on age, ZIP, and network
Great for frequent travelers or specialists

Want the best plan for your ZIP?

We’ll verify your doctors, prescriptions, and compare Marketplace vs Private PPO options.

Get Free Quotes Book a Call

FAQ

Do I have to update my income each year?

Yes. Incorrect income can cause large tax-credit paybacks at tax time.

Can I change plans after December 15th?

Yes — you have until January 15th. But changes after 12/15 start February 1st.

Can you confirm my doctors?

Absolutely. We verify every doctor, hospital, specialist, and medication before you enroll.

Robert Adams 10/30/22 Robert Adams 10/30/22

OPEN ENROLLMENT IS HERE

Open Enrollment is open. 2026 premiums, networks, and deductibles are changing again. Here’s what to check now to avoid paying more or losing your doctors.

ENROLLMENT HELP • OPEN ENROLLMENT 2026

Written by Robert Adams

Open Enrollment Is Here: How to Avoid a Bad 2026 Plan

Open Enrollment is the short window each year when you can reset your coverage for the next calendar year. For 2026, premiums, deductibles, and networks are all shifting again. If you simply let your plan auto-renew, you could end up paying more, losing doctors, or getting stuck with the wrong deductible. Here’s what to do while Open Enrollment is open.

Key Dates While Open Enrollment Is Active

Open Enrollment Window

Normally runs November 1st through mid-January
Best time to compare plans before 2026 rates fully kick in

Priority Deadline

Mid-December cutoff for a January 1st start
Miss this and your new plan may not start until February

Final Change Deadline

Last day of Open Enrollment is usually mid-January
After this, changes typically require a qualifying life event (SEP)

Why You Shouldn’t Just Auto-Renew

Your 2025 plan can come back in 2026 with new premiums and out-of-pocket costs.
Doctor and hospital networks can quietly change—your provider may no longer be in-network.
Prescriptions may move to a different tier or require new prior authorizations.
If you don’t actively review options, you could pay more for less coverage all year long.

Marketplace vs Private PPO: What to Check Right Now

If You’re on the ACA Marketplace

Re-run your income and household size—tax credits can change year to year.
Confirm your doctors and main hospitals are still in-network.
Review deductibles, copays, and out-of-pocket maximums for 2026.
Watch for HMO/EPO restrictions and referral rules.

If You Qualify for Private PPO Options

Check nationwide PPO access if you travel or live in more than one state.
Confirm no referral requirements for specialists when eligible.
Compare total cost: premium + expected usage, not just the monthly price.
Good fit for self-employed, 1099, and families who want provider flexibility.

Want the right 2026 plan for your ZIP?

During Open Enrollment, we’ll verify your doctors and prescriptions, compare Marketplace and Private PPO options, and lay out the numbers in plain English before you decide.

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FAQ

Do I have to re-apply every Open Enrollment?

What if I miss the mid-December deadline?

Can you help me compare Marketplace vs Private PPO?

Open Enrollment 2026 • health insurance deadlines • ACA Marketplace plans • Private PPO plans • health insurance quotes • RKA Insurance Advisors • self-employed health coverage

Robert Adams

https://www.RKAInsuranceAdvisors.com