Individual Health insurance
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Questions About Individual Health Insurance
Health Insurance: Get the answers you're looking for.
What is the Affordable Care Act (ACA)?
The ACA is federal law that requires most people to have health coverage meeting minimum standards. You can enroll through your state’s exchange during Open Enrollment.
When can I enroll or change my ACA plan?
Open Enrollment runs November 1–December 15 for coverage starting January 1. Outside that, you qualify only if you have a Special Enrollment Event (e.g., marriage, birth).
How do I qualify for premium tax credits?
If your household income is between 100%–400% of the federal poverty level, you may get federal subsidies to lower your monthly premium.
What essential health benefits are covered?
All ACA plans must cover 10 categories: preventive care, hospitalization, prescription drugs, mental health and more.
Can I keep my doctor?
If your doctor participates in your chosen network (HMO/PPO), you can keep them. Check the plan’s provider directory before enrolling.
What if I lose coverage outside Open Enrollment?
You get a 60-day Special Enrollment Period if you lose other qualifying coverage, including job-based plans or Medicaid.
Do I have to file tax forms for my ACA plan?
Yes. You’ll get Form 1095-A showing your coverage and premium tax credit. File it with your federal return to reconcile credits.
What are my out-of-pocket maximums?
ACA plans have annual limits ($9,450 individual; $18,900 family in 2024). After you reach this, the plan pays 100% of covered costs.
Are pre-existing conditions covered?
Yes—insurers cannot deny or charge more based on health history.
How do I find local help?
If you’d like personalized assistance, please provide your contact information and a member of our team will reach out to you directly. You can also contact us at:
- Email: support@simplestartinsurance.com
- Phone: +1 786-730-9658
Alternatively, visit our website: simplestartinsurance.co