FAQ About Marketplace/ACA Insurance

No. Individuals can enroll during the Open Enrollment from November 1 to December 31 for coverage that begins in January.  Outside of open enrollment, individuals need a Qualifying Life Event to have a Special Enrollment such as loss of coverage, marriage or having a baby.

It is always recommended to check your favorite doctor's to see if they are in the plan's network. Using the insurance carrier's provider lookup tool is the best way to verify if your providers are in-network or out-of-network before joining that plan.

Available plans will vary in the prescriptions they cover.  Is it best to check the insurance carrier's plan formulary or list of covered drugs to find out the associated costs and tiered co-pays. It is important to note that insurance carriers may also include limitations such as step-therapy substitutions, quantity limits and prior authorizations.  

Your deductible is the amount that you have to pay out of pocket before the insurance starts to pay. The max out of pocket is the total amount you could pay for services in that given year.  Once the max has been met, you are generally covered for all medical services (in network) for the remainder of the year. Plans with lower monthly premiums, generally have higher deductibles, and vice versa.

Depending on your tax household size and yearly income, you may qualify for financial discounts or tax credits through the Marketplace.