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Health insurance can be complicated, especially when comparing Marketplace plans, private options, provider networks, and subsidy eligibility. A licensed broker helps simplify the process and guide you toward coverage that fits your needs and budget.

Benefits of Working With a Broker:

• Personalized plan recommendations
• Help estimating ACA subsidy eligibility
• Assistance understanding deductibles and out-of-pocket costs
• Provider and prescription drug comparisons
• Guidance during special enrollment situations
• Ongoing support throughout the year

A broker also helps you avoid costly mistakes such as choosing the wrong network or missing enrollment deadlines. In most cases, there is no additional cost to use a licensed broker.

The ACA Marketplace has an annual Open Enrollment Period, but you may also qualify for a Special Enrollment Period if you experience a qualifying life event.

Open Enrollment
For most states, Open Enrollment typically runs from November 1 through January 15. During this time, you can enroll in a new plan, change plans, or update your subsidy information.

Special Enrollment Periods (SEP)
Outside of Open Enrollment, you may qualify if you experience events such as:

• Losing employer coverage
• Marriage or divorce
• Having a baby
• Moving to a new coverage area
• Turning 26 and losing coverage under a parent’s plan

Most Special Enrollment Periods last 60 days from the qualifying event. A broker can help determine your eligibility and guide you through the process.

Losing employer health insurance is a qualifying life event, giving you several coverage options.

Common Options Include:

• ACA Marketplace plans: Many people qualify for financial assistance (subsidies) to lower monthly premiums and deductibles.
• COBRA continuation coverage: Allows you to keep your current plan, but you are usually responsible for the full premium.
• Private individual plans: Independent health insurance options outside the marketplace.
• Short-term medical plans: Temporary coverage in some situations.

Important Timing:
You generally have 60 days to elect COBRA or enroll in a Marketplace plan after losing coverage. Comparing all available options before making a decision can help you avoid overpaying.

ACA subsidies help lower the cost of health insurance purchased through the Marketplace. There are two primary types:

1. Premium Tax Credits
These reduce your monthly insurance premium. Eligibility depends on:

• Household income and size
• Age and ZIP code
• Cost of plans in your area

2. Cost-Sharing Reductions (CSR)
Additional savings available on qualifying Silver plans to lower:

• Deductibles and copays
• Maximum out-of-pocket costs

Note: Subsidies are based on estimated annual household income. Changes should be reported during the year, and final amounts are reconciled on your federal tax return.

COBRA allows you to continue your employer-sponsored insurance, providing continuity but often at a higher cost since employer contributions usually end.

Advantages of COBRA:

• Keep your current doctors and network
• Maintain current prescriptions and treatment plans
• Helpful if you already met your deductible for the year

Why Consider ACA Plans Instead?

• Lower monthly premiums: Subsidies can significantly reduce costs.
• New limits: New deductibles and out-of-pocket limits may be more favorable.

The best option depends on your medical needs, provider preferences, and budget. A broker can help compare total yearly costs — not just monthly premiums — to help you make an informed decision.