Frequently Asked Questions


How do I edit my information or add applicants while browsing?

After clicking See Plans & Pricing, locate the panel in the top left corner displaying your application details. Click the “Edit” button, then add your spouse and dependents as needed. You can also update your household or personal information from this section before submitting your application.


What is an HMO vs. a PPO?

HMO (Health Maintenance Organization): Offers lower costs and a smaller network of healthcare providers. You typically need to select a primary doctor and obtain referrals to consult with specialists. HMO plans often provide more substantial provider discounts because care is limited to a managed network of doctors and hospitals.

PPO (Preferred Provider Organization): Offers more flexibility in seeing specialists or out-of-network doctors, typically at a higher premium. PPO plans still offer discounted rates when you stay in-network, but out-of-network visits usually cost more, as those providers have not agreed to the same discounts.


What is the difference between Medicaid and Medicare?

Medicaid is a state-run program that helps people with limited income or resources get free or low-cost health coverage. Eligibility and benefits vary by state.

Medicare is a federal program primarily for people aged 65 and older or those with specific disabilities. The program features elements covering hospital care, doctor visits, and prescription drugs.


What is a Qualifying Life Event / Special Enrollment Period?

A Qualifying Life Event (QLE) is a significant change in your life, such as losing coverage, moving, getting married, having a baby, or a change in income that makes you eligible for a Special Enrollment Period (SEP).

An SEP allows you to sign up for health insurance outside of Open Enrollment, typically within 60 days of the event. Your new coverage start date depends on when you apply, helping you avoid any gap in protection.


What is a deductible?

A deductible is the amount you pay out of pocket each year before your insurance starts sharing costs. For example, if your deductible is $2,000, you will pay that amount for covered services before coinsurance or copays apply. Some people choose higher deductibles to lower their monthly premiums, while others prefer lower deductibles for more predictable yearly costs.


What is the difference between coinsurance and a copay?

Both coinsurance and copays are ways you share costs with your health insurance company, but they work differently.

A copay is a fixed amount you pay upfront for certain services, such as $25 for a doctor's visit or $10 for a prescription.

Coinsurance, on the other hand, is a percentage you pay after meeting your deductible. For example, if your plan has 20% coinsurance and your bill is $100, you pay $20, and your insurance covers $80.


What is the out-of-pocket maximum?

The out-of-pocket maximum is the most you will pay for covered care in a single year. Once you reach this limit, your plan will cover 100% of the covered services for the remainder of the year.


Do I qualify for a subsidy or discount?

Premium tax credits are calculated based on your income, household size, and ZIP code. When you build a quote here, the system automatically checks your eligibility and displays your actual discounted price, with no additional forms required.


Is my doctor covered?

Every plan has a provider network. When browsing quotes, you can check covered doctors and prescriptions before applying, so there are no surprises later.


Are preventive visits really free?

Under the Affordable Care Act (ACA), most preventive services, such as annual checkups, vaccines, and screenings, are covered at no cost to you, even before you meet your deductible.


Do I need an agent to sign up?

Not at all. You can enroll directly here without sales calls or pressure. However, if you need licensed help, our agents are available. You are always in control.


Can I change plans anytime?

Usually, only during Open Enrollment (November 1st – January 15th) or after a Qualifying Life Event, such as losing coverage, moving, or getting married. If one of these applies, you can switch or enroll right away.


Does health insurance work retroactively?

Simply put, no. Health insurance does not cover medical bills from before your plan starts. Coverage begins on your effective date, determined by the date you apply. If you sign up by the 15th, it usually starts on the 1st of the following month. If you have recently lost coverage, you may qualify for a Special Enrollment Period to quickly shop for a new plan; however, it will not cover past care.


Why are plan prices so different?

Prices vary by metal tier (Bronze, Silver, Gold), coverage level, and network size. The good news is that all ACA plans cover the same essential benefits. The main difference is what you pay out of pocket versus your monthly premium.


Why do some plans say Marketplace and others do not?

Marketplace plans are ACA-compliant and qualify for federal subsidies. Off-market plans may offer similar coverage but do not qualify for discounts. Both are available through Enrollment Coverage, depending on your needs.


What if I cannot afford health insurance?

If your income falls below certain levels, you may qualify for $0 premium Silver plans or Medicaid, depending on your location and eligibility. Each state runs its own Medicaid program with its own qualifying rules and application website. Our quote builder automatically checks all available options, starting with the lowest monthly premium for which you may qualify.


Why get covered at all?

Because one emergency room visit can cost thousands of dollars, health insurance protects you from unexpected expenses while giving you access to preventive care and prescription savings. Many people qualify for lower monthly costs than they expect, so it is always worth checking.