Hear From Our Valued Customers
Individual Health Insurance - ACA/Marketplace FAQ's
Does it cost more to use an insurance agent or broker?
No. There is no additional cost to you for working with a licensed agent or broker to enroll in ACA/Marketplace Insurance. Agents and brokers are compensated by the insurance carrier, not by adding a separate fee to your premium. Your monthly premium will be the same whether you enroll yourself or with the assistance of a licensed broker.
Working with an agent or broker provides added support with comparing plan options, reviewing provider networks, prescriptions, understanding benefits, costs and navigating enrollment, and making sure questions on the application are answered accurately.
Can I get ACA/Marketplace Health Insurance if I am self-employed?
YES! Self-employed individuals, independent contractors, freelances, and small business owners can obtain coverage through the marketplace.
Do ACA/Marketplace plans automatically renew each year?
In some cases, it may automatically renew if you do not make a new selection. HOWEVER, your plan, premium, provider network, benefits, deductible, or financial subsidy assistance may change. In some cases, your current plan or carrier may no longer be available and you can enroll into a different plan.
Should I review my ACA/Marketplace plan every year?
YES. It is VERY important you review your coverage each year, even if you are happy with your plan and have not had any household changes. Insurance companies, premiums, deductibles, provider networks, prescription coverage, and plan benefits can change annually. You should also confirm that your household information, address, income, and family size are accurate so your eligibility and financial assistance are calculated correctly.
Schedule your 15 Open Enrollment Plan Review with Cassie here!
When is Open Enrollment for ACA/Marketplace Health Insurance?
November 1-December 15th for coverages effective January 1st
What if I missed enrolling during 11/1-12/15?
For 2027, you can still enroll December 16-January 15th for coverages effective February 1st
Can I enroll in ACA/Marketplace coverage outside Open Enrollment?
If you have a qualifying ‘Special Enrollment Period’. Yes. See later question regarding list of SEPs.
Can I change my plan during the year?
Short answer - No. Unless you qualify due to a Qualifying Life Event, such as moving to a new county or service area where you current planned is not offered, getting married, getting divorced, or loss of other coverage
Can I get ACA/Marketplace coverage if I have a pre-existing condition?
Yes! ACA Marketplace plans cannot deny you coverage, charge you more, or exclude benefits because of pre-existing health conditions.
Can I keep my current doctors and prescriptions with an ACA/Marketplace plan?
Provider networks and prescription formularies vary by insurance company and plan. Before enrolling, it is important to have Cassie review your doctors, hospitals, medications, and preferred pharmacies to make sure the plan fits your needs. This is one of the areas where working with a licensed broker can be ESPECIALLY helpful!
How much does ACA/Marketplace Health Insurance cost?
The cost of coverage depends of several factors such as age, county of residence, household size, plan selection, and whether you qualify for a subsidy. Many individuals and families qualify for subsidy tax credit that lowers their monthly premium or provides them access to a $0 monthly premium.
Do I qualify for a subsidy or premium tax credit?
Eligibility for subsidy or premium tax credit is generally based on your projected household income, household size, tax-filing status, and access to other qualifying health coverage. Your eligibility is determined during the Quoting and Application.
How is my subsidy or premium tax credit calculated?
Premium tax credits or subsidies are calculated using your projected annual household income, household size, location and cost of plans available in your area. Because the credit is based on estimated annual income, it is important to report income accurately and update the Marketplace if your income changes during the year. You can update as often as needed!
What income do I need to report on my ACA/Marketplace application?
Marketplace applications generally use your expected household income for the coverage year, including income for household members who are required to be included on your tax return. Because financial assistance is based on projected annual income, it is important to provide the most accurate estimate possible and report significant changes during the year.
Are there ‘Special Enrollment Periods’ as known as SEP in which I can obtain health insurance outside of Open Enrollment dates listed above?
Unless otherwise specified, you have 60 days from the last date of coverage to enroll in coverage during a qualified SEP.
Yes! If you lost coverage due to:
Loss of coverage through spouse or parent: Includes divorce, death, loss of dependent status, or aging off a parent's plan. Turning 26 can qualify. Must have had previous coverage through marriage, spouse or parent.
Loss of Individual Health Coverage - Examples - Plan continuation, loss of student coverage, moving outside the plan service area
Loss of employer or group coverage: Due to end of employment and you had coverage through employer or the employer no longer is offering health insurance
Loss of COBRA - ONLY if it expires, not voluntarily dropping COBRA.
Loss of Medicaid or CHIP - Loss for any reason (income to high, not reapply etc) allowed up to 90 days after loss
Late Medicad or CHIP Denial - Particularly when the original application was timely BUT Medicaid/CHIP determination occurred after the Open Enrollment of SEP expired
Birth of a baby - Coverage can generally be effective back to the date of birth
Adoption/Foster Placement - Coverage can generally be retroactive to the qualifying event date
Court Order Adding a Dependent - Coverage generally retroactive to the event date.
Moving into the US from another country/territory - Can qualify without the normal prior-coverage requirement
Moving to/from School, seasonal work, or transitional housing: Must actually establish a new residence; vacation/temporary relocation will not count
Leaving Incarceration - Becoming newly eligible for Marketplace coverage after release
Becoming U.S. Citizen - Can trigger, simply changing from one lawful immigration status to another generally does not.
Federally Recognized Tribe/ANCSA Shareholder - Special rules allow enrollment or plan changes more frequently
Domestic Abuse/Spousal Abandonment - Special rules can allow the affected individual and eligible dependents to enroll separately
New ICHRA Plan Offered by Employer - Employee and dependents can newly enroll
Marketplace Error/Misinformation/Exception Circumstances - Generally must approve the SEP based on the specific facts
How do I cancel my ACA/Marketplace coverage?
Marketplace coverage can be ended through your Marketplace account by your Agent or online through your personal portal if you set one up, but the timing of the cancellation is important! Before canceling, make sure you understand when your coverage will end and whether you have replacement coverage in place, since voluntarily canceling a plan generally does not create a SEP to enroll again later.
Group/Employee Benefits FAQ's
How does offering employee benefits help my company?
This is my favorite question to answer!
By offering benefits to your employees you attract and retain quality employees, increase your competitiveness in the hiring market, reduce employee turnover, increase overall employee workplace satisfaction, allow employees access to group insurance options they may not have individually, and make your compensation package more competitive!
Benefits such as health, dental, vision, life, and supplemental insurance can provide employees with greater financial security while helping your business stand out in a competitive job market. Depending on the type of plan and how it is structured, employer contributions toward certain benefits may also be considered a deductible business expense.
Employee benefits do not have to be a one-size-fits-all solution. As a benefits broker I can help your company evaluate options based on your budget, number of employees, workforce needs, and long-term goals.
As a company, am I required to offer health insurance in Texas?
Not always. In Texas, companies with fewer than 50 full-time and full-time equivalent employees are not required to provide health insurance and are not subject to the ACA employer shared responsibility penalty.
Companies that average 50 or more full-time and full-time-equivalent employees during the prior year are subject to offer health coverage to full-time employees and their dependents or face an employer penalty.
As a company, am I required to pay a portion of health insurance or benefits in Texas?
Not always. Employer contribution requirements depend on the type of benefit offered, the insurance carrier, and the plan selected. For traditional group health insurance, some insurance companies require the employer to contribute a minimum percentage toward the employee’s premium, while others may allow more flexibility.
Your broker can help you review contribution options and design a benefits package that fits both your company’s budget and your employees’ needs.
As a company, can I offer other benefits without offering health insurance in Texas?
If your company has fewer than 50 full-time and full-time equivalent employees you are not required to provide health insurance. You can offer other benefits, such as Dental, Vision, Life Insurance, Disability, Cancer, Critical Illness, Accident, Hospital and other items.
You can offer these benefits without a requirement of contribution!
When am I eligible to enroll in benefits?
Eligibility depends on your employer’s benefit plan and company policies. New employees may have a waiting period before coverage begins, while existing employees can generally enroll during the company’s annual Open Enrollment period. Certain qualifying life events may also allow you to enroll or make changes outside Open Enrollment.
Can I cancel my health insurance or benefits at any time?
Usually, no. Employer-sponsored health insurance is generally elected for the plan year and cannot be canceled midyear unless you experience a qualifying life event or another permitted change under the plan. Before canceling coverage, speak with your employer or benefits representative so you understand when coverage will end and whether you can re-enroll later.
When does my coverage begin?
Your coverage effective date depends on your employer’s plan rules. Coverage may begin on your date of hire, the first of the month following your hire date, or after a specific waiting period. Your employer or benefits representative can confirm your exact effective date.
Can I add my spouse or children?
In most cases, yes, if your employer’s plan allows dependent coverage. You can generally add eligible dependents when you first enroll, during Open Enrollment, or after a qualifying life event such as marriage, birth, adoption, or loss of other coverage. Documentation may be required.
What is a qualifying life event?
A qualifying life event is a change in your personal or family circumstances that may allow you to enroll in or change benefits outside your employer’s regular Open Enrollment period. Common examples include marriage, divorce, birth or adoption of a child, loss of other health coverage, or certain changes in employment or dependent eligibility. This is when you can take someone off of your coverage or add someone to your coverage. Cancellations are subject to the question listed above.
How long do I have to report a qualifying life event?
The deadline depends on your employer’s plan, but many plans require changes to be requested within 30 days of the qualifying event. Some events may have different deadlines. Because these timeframes can be strict, contact your employer or benefits representative as soon as possible after the event.
What happens if I miss Open Enrollment?
If you miss Open Enrollment, you may have to wait until the next annual enrollment period to enroll in or change benefits unless you experience a qualifying life event that gives you a special enrollment opportunity during the year.
Do my benefits automatically renew each year?
Some employer benefits may automatically continue into the next plan year, while others require you to actively re-enroll. Plan costs, deductibles, benefits, providers, and employee contributions may also change from year to year, so it is important to review your benefit elections during each Open Enrollment period.
Can I decline employer coverage?
Yes. Employees can generally decline employer-sponsored health insurance if they do not want to enroll. However, declining coverage may affect your ability to enroll later during the year unless you experience a qualifying life event.
Can I enroll in Marketplace coverage instead?
You may choose to purchase coverage through the Health Insurance Marketplace instead of enrolling in your employer’s health plan. However, if your employer offers coverage that meets federal affordability and minimum-value requirements, you may not qualify for Marketplace premium tax credits or other financial assistance.
What happens to my benefits if I leave my job?
Your benefits may end on your last day of employment or at the end of the month, depending on your employer’s plan. You may have options to continue certain coverage through COBRA or state continuation, enroll in another employer’s plan, or qualify for a Special Enrollment Period through the Health Insurance Marketplace. Some benefits, such as life insurance or supplemental coverage, may also offer conversion or portability options. Ask your agent, Cassie Sparkman.
Medicare FAQ's
How much does Medicare cost?
No. There is generally no additional cost to you for working with a licensed Medicare insurance agent or broker. Agents are typically compensated by the insurance company when you enroll in an eligible plan. Working with a broker can help you compare available options, review doctors and prescriptions, understand benefits and costs, and make an informed decision about your Medicare coverage.
Can I get ACA/Marketplace Health Insurance if I am self-employed?
Medicare costs vary depending on the coverage you choose, your income, and whether you have additional coverage. Most people receive Medicare Part A without a monthly premium. In 2026, the standard Medicare Part B premium is $202.90 per month, although higher-income beneficiaries may pay more. Medicare Advantage, Part D prescription drug plans, and Medicare Supplement plans may have additional premiums and out-of-pocket costs that vary by plan.
What are Medicare Parts A, B, C, and D?
Part A is hospital insurance and generally helps cover inpatient hospital care, skilled nursing facility care, hospice, and certain home health services.
Part B is medical insurance and generally helps cover doctor visits, outpatient care, preventive services, durable medical equipment, and other medically necessary services.
Part C, also called Medicare Advantage, is an alternative way to receive your Medicare benefits through a Medicare-approved private insurance company. Medicare Advantage plans include Part A and Part B coverage and many plans also include prescription drug coverage.
Part D provides prescription drug coverage through private insurance companies approved by Medicare.
Do I have to enroll in Medicare when I turn 65?
Not necessarily. Whether you should enroll at age 65 depends on your individual situation and whether you or your spouse have qualifying employer-sponsored health coverage. Delaying certain parts of Medicare without qualifying coverage can result in late-enrollment penalties or gaps in coverage, so it is important to understand your options before your 65th birthday.
When should I enroll in Medicare?
For most people, the Initial Enrollment Period begins 3 months before the month you turn 65, includes your birthday month, and continues for 3 months after, giving you a 7-month enrollment window. If you are already receiving Social Security benefits, you may be automatically enrolled in Medicare Parts A and B. Your individual circumstances can affect when you should enroll, so reviewing your options several months before turning 65 is recommended.
What if I am still working when I turn 65?
You may be able to delay Medicare Part B without a late-enrollment penalty if you or your spouse are actively working and you have qualifying employer group health coverage. The rules can depend on the type of coverage and employer situation. COBRA and retiree coverage do not follow the same rules as coverage based on current employment, so it is important to review your situation before delaying Medicare.
What is the difference between Original Medicare and Medicare Advantage?
Original Medicare is provided directly through the federal government and includes Medicare Parts A and B. You can generally see any doctor or hospital in the United States that accepts Medicare. You may also purchase a separate Part D prescription drug plan and Medicare Supplement coverage.
Medicare Advantage, also called Part C, is offered through Medicare-approved private insurance companies. These plans provide Part A and Part B benefits and often include prescription drug coverage and additional benefits. Medicare Advantage plans may use provider networks and have plan-specific copays, deductibles, and coverage rules.
What is the difference between Medicare Advantage and Medicare Supplement?
A Medicare Advantage plan is an alternative way to receive your Medicare benefits through a private insurance company. You remain enrolled in Medicare but receive your covered Part A and Part B services through the Medicare Advantage plan.A
Medicare Supplement, also called Medigap, works alongside Original Medicare and helps pay certain out-of-pocket costs that Original Medicare does not pay. Medicare Supplement plans do not replace Original Medicare and generally do not include prescription drug coverage, so a separate Part D plan may be needed.
You cannot use a Medicare Supplement policy to pay Medicare Advantage plan copays or deductibles.
Do I need a Medicare Part D prescription drug plan?
If you choose Original Medicare and do not have other creditable prescription drug coverage, enrolling in a Part D plan is generally recommended even if you currently take few or no medications. Going 63 days or more without creditable drug coverage after becoming eligible can result in a Part D late-enrollment penalty if you enroll later.
Many Medicare Advantage plans already include Part D prescription drug coverage.
Can I keep my doctors and prescriptions?
It depends on the coverage you choose. With Original Medicare, you can generally see any provider in the United States who accepts Medicare. Medicare Advantage plans may have provider networks, so it is important to verify that your doctors, hospitals, and other providers participate in the plan.
Prescription drug coverage also varies by plan. Each Part D or Medicare Advantage prescription drug plan has its own formulary, pharmacy network, copays, and coverage rules. Reviewing your doctors and medications before enrolling or changing plans is an important part of choosing Medicare coverage that fits your needs.
When can I change my Medicare plan?
There are several Medicare enrollment periods when changes may be allowed.
The Annual Enrollment Period, October 15 through December 7, allows Medicare beneficiaries to make certain changes to Medicare Advantage and prescription drug coverage for the following year.
The Medicare Advantage Open Enrollment Period, January 1 through March 31, allows individuals already enrolled in a Medicare Advantage plan to make certain changes.
You may also qualify for a Special Enrollment Period during the year because of specific circumstances, such as moving, losing qualifying coverage, becoming eligible for certain assistance programs, or other qualifying events.
The enrollment period and changes available depend on your current coverage and circumstances.
What is a Medicare Special Enrollment Period?
A Medicare Special Enrollment Period, or SEP, is a period outside the regular enrollment windows when certain qualifying circumstances allow you to enroll in or change Medicare Advantage or prescription drug coverage. Examples may include moving, losing employer or other qualifying coverage, gaining or losing Medicaid eligibility, receiving Extra Help, moving into or out of certain institutions, or other qualifying events. The length of the SEP and the changes you are allowed to make depend on the specific situation.
Can I change Medicare Supplement plans later?
Possibly. Medicare Supplement, also called Medigap, does not follow the same annual enrollment periods as Medicare Advantage or Part D. After your six-month Medigap Open Enrollment Period ends, you may be able to apply for another Medicare Supplement plan, but unless you have a guaranteed-issue right or another protection under state or federal law, the insurance company may require medical underwriting and may decline your application or charge a different premium.
Because you may not be guaranteed acceptance into another Medigap plan, it is important not to cancel your existing coverage until your new policy has been approved and you understand when the new coverage will begin.