Frequently Asked Questions

The Marketplace estimates a monthly discount—called the Advance Premium Tax Credit (APTC)—using your projected 2026 household income and tax household size. The credit lowers your monthly premium immediately. At tax time, you reconcile the advance credit with your actual yearly income on your federal return. If your income was higher than projected, you may owe back a portion of the credit; if it was lower, you may get additional credit. We help you set a realistic income estimate and update it if anything changes mid-year so you don’t get surprised in April.

Tip: If your situation is variable (self-employed, seasonal, multiple jobs), we’ll discuss a conservative approach to APTC so you avoid owing back large amounts at tax time.

CSR lower what you pay when you use care—deductibles, copays, and out-of-pocket maximums. They’re only available on **Silver** plans and only for households within qualifying income ranges. When CSR applies, a Silver plan can feel like a “Gold-plus” plan in terms of usage costs. We’ll check your eligibility and show the true, apples-to-apples value between Bronze, Silver (with CSR), and Gold.

Every carrier maintains its own provider directory—and networks change. We collect your doctors and clinics, then verify availability across your candidate plans. If a favorite provider is out-of-network, we’ll show plan alternatives or estimate the real cost impact of going out-of-network so you can decide with confidence.

Good to know: HMO/EPO plans usually require you to stay in-network (except true emergencies); PPO plans are more flexible but can be pricier. We’ll match the network type to how you actually use care.

Plans sort medications into tiers (generic, preferred brand, non-preferred, specialty). Each tier has its own copay or coinsurance. We compare your medication list to each plan’s formulary (its covered drug list), check any prior authorization or step-therapy rules, and estimate monthly costs. If there’s a more affordable therapeutic alternative, we’ll flag it for a conversation with your provider.

Generally: during **Open Enrollment** or if you have a **Qualifying Life Event (QLE)** (e.g., loss of coverage, move, marriage, birth, certain income changes). Coverage typically starts the 1st of the month after you select a plan and pay the first premium. We manage the timing so your start date stays on track and there’s no gap.

Premiums are the monthly cost to keep your plan active. Out-of-pocket costs include copays, coinsurance, and what you pay until the deductible and out-of-pocket maximum are met. We map your doctors, prescriptions, and likely usage to total yearly costs, not just the premium—because the “cheapest” plan per month isn’t always the best value for the care you actually use.

Have full legal names, dates of birth, Social Security numbers (if applicable), a valid address, email, and phone; plus income information for 2026 (W-2s, recent pay stubs, 1099s, Social Security statements, or a projection if self-employed). If you’re not a U.S. citizen, bring your eligible immigration documentation (e.g., Green Card, EAD, naturalization record). We’ll confirm what’s necessary before your appointment so the application goes smoothly.

Tell us as soon as you can. We’ll update your Marketplace application so your monthly tax credit adjusts appropriately. This helps avoid owing back credits at tax time and can reduce your premiums immediately if your income drops.

If you receive APTC, the IRS requires you to file a federal return to reconcile credits. Most households do anyway. We’ll provide your Marketplace 1095-A quickly and explain where that information is used.

Yes. Your plan isn’t active until the initial premium is paid. We’ll walk you through that payment with the carrier and verify your effective date so you’re covered when you expect to be.

Moving across rating areas or states usually requires selecting a new plan. We’ll help you compare your new area’s networks and formularies, and transfer care with minimal disruption.

No. Our licensed brokers are compensated by carriers. You pay the same plan price you’d see on your own—but with expert guidance, accurate enrollment, and year-round support.