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09/22/2026

A Marketplace plan cannot put a yearly or lifetime dollar limit on any essential health benefit. The old story where the policy 'maxes out' in the middle of a cancer treatment cannot happen on these plans.

Before 2014 a plan could cap what it paid over a lifetime, often at one or two million dollars, and a long illness could reach the cap. That cap is gone for the ten essential benefits.

What still has a limit is you, and it works in your favor. Your out of pocket maximum is the most you pay in a year. Above it, the plan pays.

So the two numbers to know on any plan are the deductible and the out of pocket maximum. There is no third number where the plan stops.

Comparing plans this fall? Call (844) 944-7526 and we will read the two numbers with you.

09/22/2026

The bills in your house do not stop with your paycheck. Example: $4,000 a month is $240,000 over five years. A life insurance policy pays your family a set amount, usually free of income tax. What it costs depends on your age and your health, and the earlier you ask, the lower the number.

Want the number for your household? Call (844) 944-7526.

09/21/2026

Your Marketplace plan has to cover your child's dentist. It does not have to cover yours. That is not a mistake in the plan, it is how the list of required benefits was written.

Pediatric services, including oral and vision care, are one of the ten essential health benefits every Marketplace plan must include. Adult dental and adult vision are not on the list.

So for a child on your plan: dental checkups, cleanings and eye exams run through the plan. For you: a separate dental plan, bought separately, or you pay the dentist directly.

One detail to check. In some plans the children's dental benefit sits in a separate dental plan sold alongside the health plan. Ask before you assume it is inside.

Kids on your plan this year? Call (844) 944-7526 and we will check where their dental sits.

Therapy is covered on every Marketplace plan the way a doctor's visit is: it is one of the ten essential benefits, and t...
09/21/2026

Therapy is covered on every Marketplace plan the way a doctor's visit is: it is one of the ten essential benefits, and the parity rule means the plan cannot limit it more strictly than medical care. Check the therapist is in network and the visit runs through your copay.

Send this to someone paying cash for sessions. Call (844) 944-7526.

09/20/2026

Your health plan has to cover a breast pump. Rental or one you keep, and the breastfeeding counseling that goes with it, for as long as you are nursing. Most people never ask.

That is a rule for Marketplace plans and for most job plans too. The plan may decide whether the covered pump is manual or electric, how long a rental lasts, and when you get it, before or after the birth.

The support side is covered as well: lactation counseling and the equipment, at no cost when you use an in-network provider.

The practical step is one call to the plan before the baby comes, asking which pumps and which suppliers are covered. Buying first and asking later is how people end up paying for it.

Expecting this year? Call (844) 944-7526 and we will find the line in your plan.

09/20/2026

On a Marketplace plan the most you can owe this year is $10,600, and an accident is how people find out what that means. Until the deductible is met, the emergency room, the x-ray and the cast are yours. An accident plan is a private policy that sits beside your health plan, does not replace it, and after a covered accident pays a set amount in cash. The bill in the video is an example.

Want to see what one costs next to your plan? Call (844) 944-7526.

09/19/2026

Two disability payments come from the same agency and get opposite answers on the Marketplace application. SSDI counts as income. SSI does not.

Social Security Disability Insurance (SSDI) is based on your work record. The application counts it, the full monthly amount, before any deductions.

Supplemental Security Income (SSI) is based on need. The application does not count it at all.

The same logic runs through the rest of the list. Regular Social Security counts, even the part that is not taxed. Veterans' disability payments do not count. Workers' compensation does not count.

Which one is on your letter? If you are not sure, call (844) 944-7526 and we will read it with you.

09/19/2026

An employer that hands you a monthly allowance instead of a health plan has made you an offer of coverage. It is called an individual coverage HRA. If the allowance counts as affordable under the Marketplace test, you cannot get the premium tax credit, even if you turn the allowance down. Run both numbers before you answer.

Send us the offer letter and we will run both. Call (844) 944-7526.

Every Marketplace plan covers the same ten essential benefits: outpatient care, emergencies, hospital stays, maternity a...
09/18/2026

Every Marketplace plan covers the same ten essential benefits: outpatient care, emergencies, hospital stays, maternity and newborn care, mental health, prescriptions, rehab, labs, preventive care, and pediatric care including kids' dental and vision. Adult dental and vision are not on the list, and no plan can put a yearly or lifetime dollar limit on any of the ten.

Save this for open enrollment. Questions? Call (844) 944-7526.

09/18/2026

Your household on the Marketplace application is your tax household, not the people who need a plan. A dependent you claim on your taxes counts, even if they are covered somewhere else.

The application counts you, your spouse if you file together, and everyone you claim as a tax dependent. It counts their income too.

So a college student on your return counts, even on a school plan. A parent you claim counts, even on Medicare. Leave them off and the household size is wrong, which makes the tax credit wrong.

The other direction matters as well. A roommate, a partner you do not file with, or an adult child you no longer claim is not in the household, even if they live with you.

Who is on your tax return this year? Not sure how that maps to the application? Call (844) 944-7526 and we will sort the list together.

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