Questions
The things people actually ask us.
Grouped by subject. If yours is not here, telephone and ask — we would rather answer it than have you guess.
Getting started
What does it cost to use you?
Nothing. We are paid a commission by the insurance carrier when we place coverage.
The premium you pay is identical whether you enrol through us, through HealthCare.gov, or over the telephone with the Marketplace directly — Marketplace premiums are filed with regulators and carry no agent mark-up.
Why would I use an agent at all?
Because someone else does the comparing, checks your doctors and prescriptions by name, and is still there in March when something goes wrong.
If you would rather do it yourself, HealthCare.gov works perfectly well and we will tell you so.
Will you ask about my health?
Not for eligibility. Every Marketplace plan is guaranteed issue — you cannot be turned down or charged more for a pre-existing condition.
We will ask which doctors you see and what you take, but only to check them against plan networks and drug lists.
When can I enrol?
Open Enrollment runs 1 November to 15 January. Outside that, you need a qualifying life event. More people qualify for one than realise it.
How long does this take?
A first conversation is about ten minutes. A full enrolment, once you have decided, usually runs half an hour.
You do not need documents in front of you to start.
Subsidies & income
I checked years ago and earned too much. Has that changed?
Possibly, yes. The rules governing premium tax credits have been revised more than once and the income ranges have widened considerably.
If you last looked more than a couple of years ago, you looked under different rules. It costs ten minutes to find out.
Which year's income counts?
The coming year's, estimated. Not last year's tax return.
This single point causes more confusion than anything else we deal with.
My income varies. How do I estimate it?
Honestly, from a realistic middle rather than a good year or a bad one — then revise it during the year as the picture clarifies.
Farming, contracting, commission and seasonal work are normal here, and the system is built to be corrected.
What if I estimate wrong?
It is squared up when you file. Estimate too low and you may repay some of the credit; too high and you get the difference back.
Reporting changes as they happen is what keeps that settlement small.
Who counts as my household?
Your tax household — everyone you claim on your return, whether or not they live with you. Not simply the people under your roof.
Adult children, supported parents and shared custody all have answers, and each changes the credit.
My employer offers coverage. Can I still get a credit?
Usually not, if the employer's offer meets the affordability and minimum-value tests.
But those tests have specific definitions and the answer is not always the obvious one, particularly for family coverage. Worth asking rather than assuming.
Plans & networks
Is Bronze the cheapest option?
Cheapest each month, not cheapest over a year.
And if your household qualifies for cost-sharing reductions — which attach only to Silver plans — choosing Bronze to save on premium can cost you considerably more than it saves.
Will my doctor be covered?
We check each one by name before you enrol.
Networks in rural counties across our four states can be narrow, and a plan that looks inexpensive is not if your hospital is outside it.
What about my prescriptions?
Every plan has a formulary — a list of drugs it covers and at what tier.
We check yours against it before you enrol, because a drug moving tiers can change what you pay substantially.
Do all plans cover the same things?
Every Marketplace plan covers the same ten essential health benefits.
What differs is the network, the drug list, and how the cost is split between premium and use.
Is dental and vision included?
Children's dental is an essential health benefit; adult dental and vision generally are not, and are bought separately.
We can quote those alongside your medical plan.
Should I just buy the cheapest plan?
Only if you could comfortably pay its deductible in a bad month.
A low premium is no bargain if the deductible is a number you could not find in an emergency.
Life changes
I missed Open Enrollment. Is that it?
Not necessarily. A qualifying life event opens a window, usually sixty days from the event.
Losing job coverage, moving, marrying, and a new baby are the common ones — but the list is longer, so ask.
COBRA or a Marketplace plan?
COBRA keeps your exact plan and your deductible progress, at the full price your employer used to subsidise.
A Marketplace plan is eligible for the premium tax credit, which COBRA is not — often decisive for a household whose income just dropped. Compare before you decide; reversing it is not always possible.
When does the sixty days start?
At the event itself — the last day of the old coverage, the date of the move, the date of the birth. Not the day you got round to thinking about it.
Some events also allow the sixty days beforehand, which is the better way to avoid a gap.
I am moving. Does that count?
If it changes the plans available to you, which between counties in our states it often does.
You will generally need proof of the new address and of coverage before the move.
We are having a baby.
Coverage can usually be backdated to the date of birth, so the child is covered from day one.
Check CHIP at the same time — a new child often qualifies when the parents do not.
Medicaid & CHIP
Can my children be covered separately from us?
Frequently, yes. Children qualify for CHIP at household incomes well above the level at which adults qualify for Medicaid.
A family where the parents use the Marketplace and the children use CHIP is common — and easy to get wrong on your own.
What if I qualify for Medicaid?
Then Medicaid is almost certainly the better answer and you will not be eligible for a premium tax credit.
We will tell you that and point you to the right state agency. We are not paid for it, and it is still the right advice.
Do the four states differ?
Yes. Medicaid eligibility rules are set state by state and differ meaningfully between Kansas, Missouri, Nebraska and Iowa.
We work out which applies to you rather than generalising.
My income dropped mid-year. What now?
Report it. Your credit may rise, and a large enough drop may make someone in the household newly eligible for Medicaid or CHIP instead.
Either way you should not keep paying as though nothing changed.
Using your coverage
When does coverage start?
Generally the first of the month after you enrol and pay the first premium, though the exact date depends on when in the enrolment period you signed up.
The first payment matters — coverage is not active until it is made.
What if a claim is denied?
Telephone us rather than emailing — appeals are time-sensitive.
You have the right to appeal, first with the carrier and then externally, and we will help you do it.
Do I have to do anything each year?
You will usually be re-enrolled automatically, which is convenient and occasionally wrong — plans change, networks change, and your circumstances change.
We review it with you each autumn rather than letting it roll.
What do I need at tax time?
A form from the Marketplace showing what credit was paid on your behalf. Your tax preparer uses it to reconcile the estimate against what you actually earned.
Keep it — filing without it holds up the return.
Can I change plans mid-year?
Only with a qualifying life event. Otherwise you are in until the next Open Enrollment.
Which is why checking doctors and prescriptions before enrolling matters as much as it does.
Still have a question?
Telephone and ask. We would rather answer it than have you guess — and it costs you nothing.