Private Insurance (PPO) : Aetna AIG Allstate America's Choice Americo Blue Cross Blue Shield Optimed Health Pivot Health United Healthcare ACA Insurance (HMO/EPO) Aetna Ambetter Blue Cross Cigna Molina Oscar United Healthcare Life Insurance Americo Ameritas Gerber Life insurance John Hancock Life insurance Manhattan Life Mutual of Omaha Optimed Health

Understanding Insurance Pricing ACA (Obamacare) Plans: Pricing is primarily based on household income, along with factors like age, location (state/zip code), and household size. The most important factor is income, as it determines eligibility for subsidies and cost savings, which can significantly reduce monthly premiums and out-of-pocket costs. Private (Non-ACA) Plans: Pricing is typically based on age, gender (in some cases), location, and overall health, rather than income. These plans do not offer income-based subsidies, so pricing remains consistent regardless of earnings. Important to Know: Just because a friend, family member, or coworker has a specific plan at a certain price does not mean you will qualify for that same plan or rate. Insurance is highly individualized, and your options will depend on your personal details, financial situation, and eligibility factors.

Understanding Medicaid Medicaid is a joint federal and state program designed to help cover medical costs for individuals and families with limited income and resources. While the federal government sets general guidelines, each state operates its own Medicaid program. This means that eligibility requirements, covered services, and benefits can vary depending on the state you live in. One of the key advantages of Medicaid is that it often covers services that other programs, like Medicare, typically do not—such as long-term care, nursing home care, and personal care services. In most cases, individuals with Medicaid have little to no cost for covered medical services. However, there may be small co-payments required for certain services or prescriptions, depending on the state and situation.

Understanding Medicare Medicare is a federal health insurance program for individuals 65 and older, as well as certain people under 65 with qualifying disabilities or medical conditions. It is managed by the Centers for Medicare & Medicaid Services (CMS), a federal agency. Because Medicare is a federal program, it follows standardized rules for coverage and costs nationwide, meaning your core benefits remain the same no matter what state you live in. Medicare is funded through U.S. Treasury trust funds, which are supported by sources such as payroll taxes and government funding authorized by Congress. While Medicare provides strong coverage, it is not completely free. Most individuals are responsible for a portion of their healthcare costs, which may include: Monthly premiums (especially for Part B and Part D) Deductibles Copayments and coinsurance

ACA (Obamacare) & Government Plans: You can enroll if you experience a Qualifying Life Event (such as losing coverage, moving, getting married, having a baby, etc.). These events open a Special Enrollment Period, allowing you to sign up outside of the standard Open Enrollment window. Private (Non-ACA) Plans: If you do not have a qualifying life event, private insurance options are typically available year-round, giving you flexibility to enroll at any time.

Common Qualifying Life Events (QLEs) These events may allow you to enroll in an ACA (Obamacare) plan outside of Open Enrollment: Losing health coverage Moving to a new area Getting married Having a baby Adopting a child Household income falling below a certain threshold (qualifying for additional savings or Medicaid) Experiencing misconduct, misinformation, misrepresentation, or inaction from someone who assisted with your coverage

Choosing the Right Type of Coverage ACA (Obamacare) Plans: These plans are often the best option if: You are not offered employer coverage You have pre-existing conditions that require comprehensive coverage You qualify for government subsidies based on income ACA plans are guaranteed issue, meaning you cannot be denied for health reasons. However, if you do not qualify for subsidies, you may be responsible for the full premium and deductible, which can make these plans more expensive. Private (Non-ACA) Plans: Private plans are typically medically underwritten, meaning eligibility is based on your health history. These plans often: Offer lower monthly premiums Provide faster access to benefits for those who qualify However, they are not ACA-compliant, which means they may have limited coverage for: Maternity Mental health services (especially severe conditions) Drug and alcohol rehabilitation For individuals who are generally healthy and do not anticipate needing those specific services, private plans can be a cost-effective alternative. Employer-Sponsored Plans: Employer plans can be a great option for employees, especially when: The plan is strong The employer contributes toward the premium However, it’s important to understand: Employers are typically only required to contribute toward the employee’s portion (often around 50%) Adding spouses or dependents can significantly increase monthly premiums, as employers are not required to subsidize those additional costs

Working with a licensed health insurance advisor gives you access to a broader range of options tailored to your specific state, needs, and budget. You’ll gain valuable insight and education on how health coverage works—helping you understand options you may not have known were available. An advisor can also identify plans and savings opportunities you specifically qualify for, ensuring nothing is overlooked. Most importantly, you’re able to compare both public (ACA/government) and private options side by side, so you can confidently choose the coverage that best fits your health needs and financial goals.

There is no required length of time you must stay on a plan—you have coverage because you need it. Your insurance should work for your current situation, and adjustments can be made as your needs change.

HMO (Health Maintenance Organization) An HMO, or Health Maintenance Organization, is a type of health insurance plan that typically requires you to receive care from doctors, specialists, and hospitals within the plan’s network. Key features of an HMO plan include: You generally must use in-network providers for covered services (except in emergencies). A referral from your primary care physician (PCP) is usually required to see a specialist. Some treatments and services may require prior authorization (approval) from the insurance company. Once approved, the authorization typically remains valid for as long as the treatment is medically necessary. HMO plans are often designed to help manage costs while coordinating care through your primary care provider.

PPO (Preferred Provider Organization) A PPO, or Preferred Provider Organization, is a type of health insurance plan that offers greater flexibility when choosing healthcare providers. Key features of a PPO plan include: You have the freedom to see any doctor, specialist, or hospital, whether they are in-network or out-of-network (out-of-network care may come with higher costs). You are not required to choose a primary care physician (PCP). Referrals are not required to see specialists, giving you direct access to care when needed. If you need medical care while traveling or away from home, you can typically seek treatment from any available healthcare provider. PPO plans are designed for individuals who want more flexibility and direct access to specialists without referrals.

EPO (Exclusive Provider Organization) An EPO, or Exclusive Provider Organization, is a type of health insurance plan that requires you to receive care from a specific network of doctors, specialists, and hospitals. Key features of an EPO plan include: You must stay within the plan’s network for covered services (except in emergencies). EPO plans often have lower monthly premiums compared to other plan types, but may come with higher deductibles depending on the plan. You typically do not need a referral to see a specialist within the network, offering more flexibility than an HMO. An EPO can be a good fit for someone who wants freedom to choose providers without referrals, while still being comfortable staying within a defined network of care

Copay (Co-Payment) A copay, or co-payment, is a fixed amount you pay for a covered healthcare service at the time you receive care. The insurance company then pays the remaining cost based on your plan benefits. If your plan includes copays, you will pay the set copay amount when you visit a provider—for example, for a doctor’s visit, urgent care, or specialist appointment. Think of a copay as your “entry fee” to see the provider. It is paid just to access the visit itself. Any additional services during that visit—such as labs, testing, imaging, or medications—may be billed separately and are subject to other parts of your insurance plan (like deductible, coinsurance, or pharmacy coverage).

Health Insurance Deductible A health insurance deductible is the amount you must pay out of pocket for covered healthcare services before your insurance plan begins to share costs. Deductibles vary depending on your plan type, coverage level, and insurance carrier. Example: If your deductible is $2,000, you are responsible for paying 100% of your covered medical costs until you have met that $2,000 amount. Once your deductible is met, your insurance typically begins to share costs with you through coinsurance, where you pay a percentage of the costs and the insurance company pays the remaining portion based on your plan.

Coinsurance Coinsurance is the percentage of the cost of a covered healthcare service that you are responsible for paying after you have met your deductible. For example, if your coinsurance is 20%, and you have already met your deductible, your insurance plan will cover the remaining 80% of the allowed cost, while you pay the 20% share. The higher your coinsurance percentage, the more you will pay out of pocket for covered services after your deductible has been met.

Health Insurance Premium A health insurance premium is the monthly payment you make to your insurance company to keep your coverage active. Think of it like a subscription fee for your health insurance plan. You must pay your premium every month, even if you do not use any medical services during that time. If the premium is not paid, your coverage may be suspended or terminated, which means you could lose access to your benefits.