What Are the Most Common Health Insurance Questions?

Open Enrollment runs November 1 through January 15 each year. Enroll by December 15 for January 1 coverage. Outside this window, you need a qualifying life event (losing coverage, marriage, baby, move) to trigger a 60-day Special Enrollment Period. Some states extend deadlines, check your state marketplace.

Without subsidies, individual ACA premiums average $400 to $600/month depending on age and location (KFF). A 30-year-old pays roughly $350 to $500/month, while a 60-year-old pays $800 to $1,300/month. Family of 4: $1,200 to $2,000/month. However, 92% of marketplace enrollees receive tax credits that reduce costs significantly.

Premium Tax Credits lower your monthly premium based on household income and family size. They're applied directly to your bill. For 2026, a single person earning up to ~$62,000 or a family of 4 earning up to ~$127,000 may qualify. A 40-year-old earning $35,000 might pay $100 to $200/month for a Silver plan after credits.

Bronze: lowest premium, 60% actuarial value, highest deductible (~$7,000 to $9,200). Silver: moderate premium, 70% AV, plus CSR benefits for lower incomes, 73% of enrollees choose Silver (KFF). Gold: higher premium, 80% AV, lower costs when you use care. Platinum: highest premium, 90% AV, lowest out-of-pocket.

Yes, with a qualifying life event: losing coverage, getting married/divorced, having a baby, moving, turning 26, or losing Medicaid. You typically have 60 days from the event to enroll. Some states offer year-round enrollment for certain populations.

CSRs are extra savings available only on Silver plans for people with incomes under 250% FPL ($37,650 for a single person in 2026). They lower your deductible (to as low as $250), copays, and out-of-pocket maximum, sometimes saving $3,000 to $6,000/year. According to KFF, this is the most underused benefit in the ACA.

To receive subsidies, yes, you must enroll through HealthCare.gov or your state's marketplace. You can buy off-exchange directly from insurers, but you won't get financial assistance. A licensed independent broker can help you navigate the marketplace at no cost to you, brokers are paid by insurance companies.

Report changes to the marketplace within 30 days. If income increases, your subsidy decreases (and you may owe at tax time if you don't update). If income decreases, you may qualify for more help. Keeping info current prevents a tax-time surprise, the average overpayment repayment is $800 to $1,200.

Yes, under the ACA, insurance companies cannot deny coverage or charge more for pre-existing conditions on any marketplace or employer plan. This is one of the ACA's most important protections and applies to all conditions including diabetes, cancer, heart disease, and mental health.

Modified Adjusted Gross Income (MAGI): wages, self-employment income, Social Security, unemployment, alimony, and investment income. Does NOT include gifts, inheritances, child support, or most scholarship income. All income for everyone on your tax return counts.

It depends on the plan's provider network. HMO plans restrict you to in-network providers. PPO plans allow out-of-network visits at higher cost. Before enrolling, check the plan's provider directory at the insurer's website. Provider networks change annually, so verify each year.

There's no federal penalty since 2019. However, some states (CA, MA, NJ, RI, DC, VT) have individual mandates with penalties of $695+ per adult. More importantly, being uninsured means one ER visit could cost $2,000 to $20,000+. Medical debt is the #1 cause of bankruptcy in the U.S.