FAQs to Guide Your Insurance Choices
Find clear answers to common questions about coverage and plans.
When can I enroll in health insurance for 2026?
You can enroll during the Open Enrollment Period (OEP), which typically runs from November 1 through January 15 in most states. If you experience a qualifying life event (like losing coverage, moving, getting married, or having a baby), you may qualify for a Special Enrollment Period (SEP) outside of open enrollment.
There are also Private and Short Term options available outside of Open Enrollment.
How do I know if I qualify for premium subsidies in 2026?
Subsidies are based on your household income and size. In 2026, enhanced premium tax credits may still apply depending on federal legislation. Many individuals earning up to 400%+ of the Federal Poverty Level may qualify. We can provide a quick income check to estimate your savings.
What’s the difference between an HMO, PPO, and EPO plan?
- HMO: Lower cost, requires staying in-network and usually requires referrals.
- PPO: More flexibility to see out-of-network providers without referrals.
- EPO: No referrals needed, but no out-of-network coverage (except emergencies).
Are telehealth services covered in 2026 plans?
Yes. Most major carriers now include telehealth and virtual care benefits, often with low or $0 copays. Many plans also include mental health teletherapy and virtual urgent care.
What is the difference between deductible, copay, and coinsurance?
- Deductible: What you pay before insurance starts sharing costs.
- Copay: Fixed amount per visit (e.g., $30 for primary care).
- Coinsurance: Percentage you pay after meeting your deductible (e.g., 20%).
Can I keep my current doctor?
It depends on the plan’s provider network. Before enrolling, we verify whether your doctors and preferred hospitals are in-network.
What happens if I miss Open Enrollment?
You generally must wait until the next Open Enrollment unless you qualify for a Special Enrollment Period due to a life event. Short-term or private plans may are available as well.
What does health insurance actually cover in 2026?
All ACA-compliant health plans are required to cover the 10 Essential Health Benefits, including:
- Preventive services (annual checkups, vaccines, screenings)
- Prescription drugs
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use treatment
- Pediatric services
- Laboratory services
- Rehabilitative services
- Chronic disease management
How do small business health insurance options work?
Small businesses (typically under 50 employees) can offer coverage through:
- SHOP marketplace plans
- Private group plans
- Level-funded plans
Tax credits may be available for qualifying small employers. We help compare cost, contribution strategy, and compliance requirements.
Why should I use an insurance agent instead of enrolling online myself?
Working with an agent:
- Costs you nothing
- Provides plan comparisons across carriers
- Helps with subsidy optimization
- Assists year-round with billing, claims, and coverage questions
Think of us as your ongoing advocate — not just enrollment help.