Health Insurance for You and Your Family
Under 65, self-employed, or between jobs? I compare health plans around your doctors, prescriptions and budget, and explain your options in plain language. Working with me costs you nothing.
Coverage that fits your life, not just your budget
In short: I look at the plans available where you live, check that your doctors and medications are covered, and help you choose and enroll. The monthly premium is only one part of the picture.
Compare plans side by side
Premiums, deductibles, copays and the most you could pay in a year, all explained so you can see the real cost of each plan.
Check doctors and drugs first
Networks and drug lists differ from plan to plan. I check yours before you enroll, not after.
Help with enrollment
I help you complete the application correctly and make sure you know what happens next.
Support all year
Questions about a bill, a claim or a change in your life? You have one person to call.
What you really pay for health insurance
In short: The monthly premium is only the starting point. Your deductible, copays, coinsurance and out of pocket maximum decide what a year of care actually costs you.
| Term | What it means | Why it matters |
|---|---|---|
| Premium | The amount you pay every month to keep your coverage. | A low premium often comes with a higher deductible. |
| Deductible | What you pay for covered care before the plan starts sharing the cost. | A higher deductible means you pay more before help begins. |
| Copay | A flat amount you pay for a service, such as a doctor visit or a prescription. | Easy to plan for, and it varies by type of care. |
| Coinsurance | Your percentage of the cost after you meet the deductible. | A hospital stay can add up quickly, even at a small percentage. |
| Out of pocket maximum | The most you can pay in a year for covered, in network care. | Your protection if you have a serious illness or injury. |
Bronze, Silver, Gold or Platinum?
Marketplace plans are grouped into four levels. The level describes how costs are shared between you and the plan, not the quality of your care. The shares below are averages across all members.
Bronze
The plan pays about 60% of costs and you pay about 40%. Usually the lowest monthly premium and the highest deductible.
Silver
The plan pays about 70% and you pay about 30%. A middle choice, and the level where some people qualify for extra savings on what they pay for care, based on income.
Gold
The plan pays about 80% and you pay about 20%. A higher premium in exchange for lower costs when you use care.
Platinum
The plan pays about 90% and you pay about 10%. The highest premium and the lowest costs when you use care.
Not every level is available in every area. Depending on your income and household size, you may also qualify for help paying your premium. I check this with you before you choose.
Understanding your network
The type of plan decides which doctors you can see and whether you need a referral. These are the four you will hear most often.
HMO
You usually choose a primary care doctor and need a referral to see a specialist. Care is generally limited to the plan’s network. Premiums are often lower.
PPO
More freedom to see doctors inside or outside the network, usually without referrals. Out of network care costs more. Premiums are often higher.
EPO
Covers care inside the network, usually without referrals, but generally does not cover out of network care except in an emergency.
POS
A mix of the two. You choose a primary doctor and need referrals, with some coverage outside the network at a higher cost.
Which plan types are available depends on where you live.
Not sure which plan fits your family? Let’s talk it through. It costs you nothing, and there is no pressure.
Three simple steps
Tell me about your situation
Use the form below: who needs coverage and the best time to call. It takes about a minute.
We talk it through
I call at a time that works for you, ask about your doctors, medications and budget, and answer your questions.
You choose, I help you enroll
You pick the plan that fits. There is no pressure, and the choice is always yours.
Is this right for you?
- You are under 65 and need health coverage for yourself or your family
- You are self-employed or run a small business
- You lost job-based coverage or are between jobs
- Your current plan is changing or getting more expensive
- You want to understand your options before open enrollment
Outside the yearly open enrollment period, you generally need a qualifying life event, such as losing other coverage, to enroll. If something has changed in your life, call me soon because enrollment windows can be limited. Plans, prices and eligibility vary by state and insurance company.
When you can enroll outside the yearly window
Most people enroll during the yearly open enrollment period. A qualifying life event can open a special enrollment period, usually for 60 days, so it is important to act quickly.
You lose job based coverage
Leaving a job or losing your employer plan usually opens a special enrollment period. You can compare a new plan with COBRA, which lets you keep your old plan but generally means paying the full premium. Do not let the deadline pass while you decide.
You turn 26
Young adults can stay on a parent’s plan until age 26. Losing that coverage usually opens a special enrollment period to choose a plan of your own.
Marriage, a new baby or adoption
These events usually let you add family members or change your coverage outside the yearly window.
You move
Moving to an area with different plans may open a special enrollment period. Tell me before you move if you can.
You start your own business
Leaving employer coverage to work for yourself is a common reason people call me. Self-employed people may be able to deduct health premiums, so ask your tax advisor.
Eligibility and deadlines vary. Call me as soon as something changes in your life, because these windows are short.
Something changed? Call me this week so we can protect your coverage.
Mistakes I help people avoid
- Choosing the lowest premium without looking at the deductible and the out of pocket maximum
- Not checking whether your doctors and hospitals are in the plan’s network
- Not checking whether your prescriptions are covered, and at what cost
- Missing the deadline after losing coverage, and going without insurance
- Assuming you do not qualify for help paying premiums without checking
- Not reviewing your plan each year, even though networks, drug lists and prices change
In short: I check every one of these for you before you enroll, so you know what you are choosing and what it will really cost.
Health insurance FAQ
Does it cost me anything to work with you?
No. My help is free to you. Premiums are set by the insurance company and are the same whether you enroll with me, on your own, or with another agent.
Can I keep my doctors?
It depends on the plan’s network. I check your doctors and hospitals before you choose a plan.
What if I am turning 65?
Medicare may be the right path. See my Turning 65 page.
Can I talk to someone first?
Yes. Call 904-583-8391 or book a consultation.
What is the difference between an HMO and a PPO?
An HMO usually limits you to its network and asks you to choose a primary care doctor and get referrals, often with a lower premium. A PPO gives you more freedom to see doctors outside the network at a higher cost, often with a higher premium. I explain which fits your doctors and your budget.
What is an out of pocket maximum?
It is the most you can pay in a year for covered, in network care. After you reach it, the plan pays covered costs for the rest of the year. Premiums do not count toward it.
Can I get help paying my premiums?
Depending on your income and household size, you may qualify for savings on Marketplace plans, and some families qualify for Medicaid or CHIP. I check this with you and point you in the right direction.
What if I lose my job?
Losing job based coverage usually opens a special enrollment period, generally for 60 days. You can compare a new plan with COBRA, which lets you keep your old plan but usually means paying the full premium. Call me early so we can compare both.
Can my children stay on my plan until age 26?
Yes. Plans that cover children must offer coverage until they turn 26, whether or not they live with you.
What should I have ready when we talk?
Your date of birth and the ages of everyone who needs coverage, your ZIP code, the names of your doctors, your prescriptions, and a monthly amount you are comfortable paying.
Get a free health quote
Tell me who needs coverage and I will call you, Monday to Friday, 8:30 AM to 5:00 PM Eastern. Prefer to talk now? Call 904-583-8391 or book a consultation.
