This varies by plan and number of individuals to be covered. Plans can be customized to fit your needs, whether you need maternity, mental health, major medical, dental and vision.
PPO (Preferred Provider Organization) Plans

PPO plans are available in most states and use a preferred provider network. Members receive lower premiums (preferred) rates. These plans typically offer more flexibility in choosing providers.

ACA (Affordable Care Act) Marketplace Plans

ACA plans vary in cost depending on the “metal level” selected. The metal tiers reflect how you and the insurance company share healthcare costs:
**Bronze Plans
• Lower monthly premiums
• Higher deductibles
• Higher out-of-pocket costs before coverage kicks in
**Silver Plans
• Moderate monthly premiums
• Doctor visit copays often included
• Moderate to high deductibles
• May qualify for cost-sharing reductions if eligible
**Gold Plans
• Higher monthly premiums
• Lower deductibles
• Lower maximum out-of-pocket costs
• Generally lower costs when receiving careWe are growth-focused, performance-driven, and committed to developing successful insurance professionals.

We can search providers in network and narrow the search to those plans most readily accepted by your doctors to insure you are covered and can go to the providers of your choice.

This is a common comparison between a PPO plan and a HMO. If on a HMO plan you will need a referral from your primary care provider to see a specialist in network. With a PPO plan you will have the greatest flexibility and choice to seek care from the providers you want to see.

With HMO coverage, no you will not have access to out of network coverage. With PPO plans members receive lower (preferred) rates when using in-network doctors and hospitals, but they can also see out-of-network providers at a higher cost.

Yes — we can search your specific prescriptions to determine whether they are covered under a particular plan. We can review each plan’s formulary (the list of covered medications) to confirm:
• Whether your medication is covered
• What tier it falls under
• Your estimated copay or cost based on the plan
• Any prior authorization or step therapy requirements
This allows us to compare plans and help you choose the option that best fits both your medical and budget needs.

Many basic plans can include dental and vision at an additional monthly cost with a separate policy. The cost will vary whether you need basic coverage for cleanings or major coverage for orthodontics.

With certain plans these are benefits that are included as an “Essential Health Benefit”. There are private plans that include basic coverage for prenatal, labor, and delivery. In addition to telemedicine coverage for psychologist and psychiatry coverage.

PPO coverage will travel well with you from state-to-state. HMO coverage will be very state/region specific, and you will need to stay in network therefore you only have coverage for ER or emergency critical care while out of state. If traveling out of the country you will be best suited to discuss with your travel agent, the best resource for travel insurance.

The standards for open enrollment with the Affordable Care Act/Obama Care/Marketplace coverage is November 1st thru December 1st for a January 1 effective date. Special Enrollment Period allows you to apply year-round with a qualifying event. You are eligible to enroll for 60 days following the qualifying event.

Common qualifying events are a relocation to new state/county. Divorce and losing coverage. Change of job with a loss of coverage. Birth of new baby or adoption. Retirement with a loss of coverage. Losing Medicaid.

Household income below 400% of the poverty level will qualify for a subsidy or premium tax credit. Income parameters vary by household size and total gross income. Penalties to pay back the subsidy will be enforced based on your IRS tax filing and gross household income reported.
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