Resources

Understand how premium tax credits work in the ACA Marketplace, what information is used, and how to avoid surprises at tax time.

What subsidies are

Premium tax credits help reduce monthly premium costs for eligible households. The amount is based on estimated household income, household size, and location.

Information that matters

• Estimated annual household income (use your best current estimate).
• Household members and dependents expected to be on the application.
• County and ZIP code (affects available coverage regions).
• Current coverage situation (to determine eligibility for enrollment timing).

Common pitfalls to avoid

• Under‑estimating income, which can lead to tax reconciliation surprises.
• Not reporting changes in household size during the year.
• Missing enrollment windows for coverage changes.

Helpful next steps

1. Gather recent income documentation (pay stubs or tax filings).
2. Confirm household members who need coverage.
3. Ask for a checklist if anything has changed recently.

For individualized guidance, connect with a licensed agent. This resource is educational and does not recommend specific plans.

ICHRA (Individual Coverage HRA) is a way for employers to offer a defined contribution toward individual coverage. This guide is general education only.

Key concepts

• Employers set a monthly allowance amount by employee class.
• Employees shop for individual coverage that meets their needs.
• Reimbursements are typically tax‑advantaged when used appropriately.

What employers should plan for

• Eligibility classes and allowance amounts.
• Employee communications and timelines.
• Documentation and ongoing administration.

What employees should ask

• When the allowance begins and how to submit reimbursements.
• What coverage options are available in your area.
• How the allowance interacts with other benefits.

For plan‑specific guidance, connect with a licensed agent after required disclosures.

Life events can open a Special Enrollment Period (SEP) outside of the annual enrollment window. Use this checklist to stay organized.

Common SEP triggers

• Loss of qualifying coverage (job-based or other health coverage ending).
• Moving to a new ZIP or county with different coverage areas.
• Changes in household size (marriage, divorce, birth, adoption).
• Other qualifying life changes tied to eligibility rules.

What to gather

• Proof of the life event (letters, notices, or official documents).
• Dates of the event (start/end of prior coverage, move date, etc.).
• Current household details and contact information.

Timing tips

• SEPs are time‑limited. Document dates and confirm the window.
• Apply promptly to avoid gaps in coverage.

If you are unsure whether your situation qualifies, ask for guidance. This resource is educational and does not determine eligibility.

This overview explains how Original Medicare works and how supplemental coverage fits in. It is general education only.

Original Medicare (Part A and Part B)

• Covers hospital and medical services.
• You can see providers who accept Medicare, depending on availability.
• Costs can include deductibles, copays, and coinsurance.

Supplemental coverage

Many people consider supplemental coverage to help with out‑of‑pocket costs. The right fit depends on budget, provider preferences, and timing.

Prescription coverage

Prescription coverage is often separate and has its own enrollment rules. It is important to understand timing before making changes.

What to compare (at a high level)

• Monthly premium range
• Provider access
• Out‑of‑pocket cost exposure
• Prescription coverage needs

For plan‑specific guidance, a licensed agent can walk through details after the required disclosures.

Starting Medicare can feel complex. This guide explains the building blocks and what to prepare before your first conversation.

The building blocks

• Part A (hospital coverage) and Part B (medical coverage) are often called Original Medicare.
• Many people add supplemental coverage and prescription coverage to round out costs.

Enrollment timing basics

• Initial Enrollment typically starts around age 65 (timing varies by situation).
• If you have employer coverage, timing can differ. Confirm before making changes.

What to prepare

1. Your preferred contact method and timing.
2. A list of doctors and medications (for general guidance).
3. Any recent coverage notices or letters.

Scope of Appointment

Plan‑specific Medicare discussions require a Scope of Appointment (SOA). We can provide education first and help coordinate the proper next steps.

This guide is educational and does not recommend specific plans.

Off‑exchange coverage refers to individual coverage purchased outside the Marketplace. This guide explains the difference at a high level.

Marketplace coverage

• Purchased through HealthCare.gov or a state Marketplace.
• May include premium tax credits for eligible households.
• Enrollment is tied to Open Enrollment or Special Enrollment Periods.

Off‑exchange coverage

• Purchased directly with a carrier or broker.
• Generally does not include premium tax credits.
• May have different enrollment timing or options.

Questions to ask

1. Are premium tax credits likely based on your household income?
2. Do you need coverage outside of Marketplace enrollment windows?
3. What documentation is required to apply?

This resource is educational and does not recommend specific plans or carriers.

Part D is Medicare prescription coverage. This guide covers what it is and how timing works.

What Part D covers

• Prescription drug coverage, typically with a formulary (covered drug list).
• Pharmacies may be in‑network or preferred.

Timing considerations

• Enrollment windows can align with Medicare eligibility.
• Late enrollment can have consequences; confirm timing before making changes.

What to gather before a discussion

1. A list of current prescriptions and dosages.
2. Preferred pharmacies.
3. Any recent coverage notices.

This is a general overview and does not recommend a specific plan.

Prescription costs can vary widely. This overview explains common cost drivers and general ways to plan ahead.

Cost drivers

• Formulary placement (preferred vs non‑preferred).
• Pharmacy networks and preferred locations.
• Generic vs brand medication availability.

What to prepare

1. A complete medication list and dosages.
2. Preferred pharmacy and backup options.
3. Any prior authorization or clinical notes you’ve received.

General tips

• Ask about generic alternatives where appropriate.
• Keep an updated medication list for any coverage discussion.

This is educational information and not medical advice.

Small group coverage decisions impact budgets, employee experience, and renewal planning. This guide focuses on the questions to ask.

Typical decision areas

• Employee eligibility and participation expectations.
• Employer contribution strategy and budget planning.
• Renewal timing and communication cadence.

What to prepare

1. Current census or headcount estimate.
2. Desired effective date and renewal month.
3. Questions from leadership or HR.

What comes next

Gathering requirements early helps avoid last‑minute changes. A licensed agent can guide next steps without making plan selections on your behalf.

Prepare a few essentials to make your first conversation quick and productive.

Basic info

• Full name and preferred contact method.
• County and ZIP code.
• Current coverage status (if any).

Helpful documents

1. Recent income information (pay stubs or tax filings) for ACA Marketplace questions.
2. Medicare or prescription details, if applicable.
3. Employer benefit summaries for small group or ICHRA discussions.

Questions to ask

• What steps are required and in what order?
• What timeline should I expect?
• What follow‑up information will you need?

We do not request sensitive identifiers through the website (SSN, Medicare ID, or bank info).