Kovered By Kalck

Your premium is what you pay each month to keep coverage active. Your deductible is what you pay out of pocket before your plan starts sharing costs. A copay is a flat fee for a visit or prescription (like $25 at the doctor). Coinsurance is your percentage of the bill after you've hit your deductible — for example, the plan pays 80% and you pay 20%.

Open Enrollment for ACA plans typically runs from November 1 through January 15 each year. Outside that window, you can enroll if you've had a Qualifying Life Event — like losing other coverage, getting married, having a baby, or moving to a new area. Short-term and supplemental plans can often be started any time of year.

The most common ones are losing job-based coverage, aging off a parent's plan at 26, getting married or divorced, having or adopting a child, moving to a new ZIP code, or a change in income that affects subsidy eligibility. You usually have 60 days from the event to enroll in a new plan.

HMO plans use a tight network and usually require referrals to see a specialist — premiums tend to be lower. PPO plans give you the most flexibility, including out-of-network care, but cost more. EPO sits in between: no referrals needed, but care must stay in-network. The right fit depends on which doctors you want to keep seeing.

Yes — under the Affordable Care Act, no ACA-compliant health plan can deny you coverage, charge you more, or refuse to treat a pre-existing condition. That includes everything from asthma and diabetes to mental health and pregnancy. (Short-term medical plans are the exception — those can underwrite, which is one of the things we'll talk through together.)

It depends on your age, ZIP code, household size, income, and which plan tier you pick. Many people qualify for premium tax credits through the Marketplace that bring monthly costs down significantly — sometimes to $0. The fastest way to know your real number is a free quote; I'll run your subsidy eligibility for you.

You have more choices than most people realize. Marketplace ACA plans, private health plans, health share programs, and dental/vision add-ons are all on the table. Self-employed clients often qualify for subsidies based on their net income, and health insurance premiums may be tax-deductible. This is one of my favorite situations to walk through.

No — working with me is completely free for you. Licensed advisors are paid directly by the insurance carriers, and the price of your plan is the same whether you enroll on your own or with my help. The difference is you get someone in your corner year-round, not just at enrollment.