Open Enrollment
The set window each year when anyone can pick a Marketplace plan or move away from the one they already hold.
Questions and Answers
The things people ask me most about Affordable Care Act coverage, answered in plain words.
Plan language
Terms You Will Meet Along the Way
Marketplace paperwork leans on a handful of phrases that never get explained on the page where they appear. Here is what each one actually means when it turns up on your screen.
Special Enrollment Period
A shorter window that opens after a life event such as a move, a marriage, a birth or the end of a job plan.
Premium tax credit
Financial help that lowers what you pay each month, worked out from your household size and the income you expect this year.
Cost sharing reduction
Extra help carried by some silver plans that trims the deductible and lowers what you hand over at each visit.
Metal levels
Bronze, silver, gold and platinum describe how a plan splits costs with you. They say nothing about the quality of the care.
Summary of Benefits and Coverage
A short standard document every plan publishes, written to the same shape so two plans can be read beside each other.
Asked most often
Answers Grouped by What You Are Weighing Up
If your question is not here, send it over with a little about your household and I will answer it against your own situation instead of in general terms.
Enrolling
Names and birth dates for everyone in the household, your best estimate of this year's income, and a short list of the doctors and medicines you want kept in the picture.
Not always. A move, a marriage, a new baby or the loss of workplace coverage can open a Special Enrollment Period, and there is a limited window to use it.
You can switch at the next Open Enrollment, and sooner than that if a qualifying life event opens a Special Enrollment Period for your household.
No. Some households land on more than one plan, and I will say so plainly if splitting them works out better for your doctors or your budget.
Costs and savings
A small monthly price usually sits beside a large deductible. If your household sees doctors often, that plan can cost more across the year than one with a higher premium.
You estimate the full year rather than a single month. Tell me how your work runs and I will show you how to put that figure together honestly.
You report the change and your financial help is adjusted from that point forward. Reporting it early is what keeps the year from ending in a surprise.
There can be. Some households qualify for extra help that lowers the deductible and trims what they pay at each visit, though it only applies on certain plans.
Doctors and prescriptions
Every plan keeps its own list of doctors, labs and hospitals. Send me the names you want to keep and I check them before that plan reaches your shortlist.
Each plan publishes its own drug list. If yours is not on it, I look for a plan that carries it, or I explain how to request an exception.
Usually at a higher cost to you, and sometimes not at all past an emergency. It is worth settling that question before you enroll rather than after.
Preventive care such as routine checkups, vaccines and recommended screenings is covered on Marketplace plans without a copay at the visit.
From Your First Message to a Plan You Picked
It takes three short steps, and you set the pace. Nothing goes to an insurance carrier until you tell me it should.
Share Your Details
Tell me who makes up your household, what you expect to earn this year and which doctors you already see.
Go Over the Plans
I explain the ACA plans that fit, with the premium, the deductible and the network laid out for each one.
Enroll in Your Pick
You choose the plan. I help you complete the enrollment form, line by line, so nothing on it gets missed.
Bring Me the Question You Are Still Turning Over
Tell me who is in your household and what you want a plan to handle. I read it myself and write back with the Affordable Care Act options that match, and the reason each one is on the list.