Under the Affordable Care Act (ACA), each state has the option to run its own health insurance marketplace, or to use the federally facilitated one through HealthCare.gov. As of 2025, some states operate fully state-run marketplaces with their own websites, deadlines, and plan offerings—while others rely on the federal government’s platform.

State-Based Marketplaces vs. Federally Facilitated Marketplaces

When the ACA was passed in 2010, it gave states the opportunity to build and manage their own health insurance exchanges. If a state declined, the federal government would step in and provide ACA-compliant plans through HealthCare.gov.

Today:

• 20 states (plus Washington, D.C.) run their own marketplaces

• 3 states use the federal platform for enrollment, but manage their own backend operations

• The remaining 28 states use the federally facilitated marketplace

State-based marketplaces allow local governments more control over how plans are regulated, priced, and promoted. They can also set their own Open Enrollment Period (OEP) dates, which is helpful for residents who need more time to enroll.

States That Operate Their Own Health Insurance Exchanges (2025)

Here are the states that currently operate their own health insurance marketplaces, along with their platform names:

• California – Covered California

• Colorado – Connect for Health Colorado

• Connecticut – Access Health CT

• District of Columbia (D.C.) – DC Health Link

• Idaho – Your Health Idaho

• Maryland – Maryland Health Connection

• Massachusetts – Massachusetts Health Connector

• Minnesota – MNsure

• Nevada – Nevada Health Link

• New Jersey – Get Covered NJ

• New York – NY State of Health

• Pennsylvania – Pennie

• Rhode Island – HealthSource RI

• Vermont – Vermont Health Connect

• Washington – Washington Healthplanfinder

Each of these states may offer unique plan choices, local insurer options, and extended enrollment deadlines beyond the federal window.

When Is Open Enrollment for ACA Plans in 2025?

The federal Open Enrollment Period for 2025 coverage is expected to run from November 1, 2024 through January 15, 2025. However, some state-run marketplaces set their own deadlines and may offer enrollment extensions.

What If You Miss Open Enrollment?

If you don’t enroll during the Open Enrollment Period and don’t qualify for a Special Enrollment Period (SEP), you may have to wait until the next OEP begins in late 2025. Here’s what happens if you don’t take action before the deadline.

Common SEP triggers include:

• Loss of other coverage

• Marriage or divorce

• Birth or adoption of a child

• Moving to a new ZIP code or state

Why Does It Matter Who Runs Your Marketplace?

If your state uses a state-based marketplace, your:

• Enrollment dates may be longer or more flexible

• Health insurance plan options may be broader or include regional carriers

• Application process may take place on a different website (not HealthCare.gov)

Looking for Health Insurance?

The best way to get the right plan for your needs is by working with a licensed health insurance agent. At EZ, our team:

• Works with top-rated insurance companies in every state

• Can help you access premium subsidies and tax credits

• Will walk you through all your health insurance options—federal and state-based

• Does all the heavy lifting for you—at no cost

To get free instant quotes, simply enter your ZIP code in the bar above, or to speak to a local agent, call 855-677-0157.

When it comes to your health insurance, Open Enrollment is the most important time of the year. This is the time that you’ll be able to change your plan, or enroll in a new one that better suits your needs and saves you money. It’s imperative that you know when the Open Enrollment Period (OEP) starts and how long it lasts so that you don’t miss out! If you do miss the OEP, you may have to wait an entire year in order to make changes, that is unless you qualify for a Special Enrollment Period (SEP). With all that being said, it’s super important to act before the deadline and avoid waiting until the last minute. To help you on this endeavor, we’ve outlined the key OEP dates for every state, to ensure you have ample time to get enrolled!

The 2025 OEP begins November 1st, 2024 in most states, and since changes to the OEP last year, it generally runs through January 15th in most states. Some states, though, have extended their OEP a little longer. Take a look at the following so you know when your state’s OEP begins and when it ends.

States With January 15th Deadlines

• Alabama
• Alaska
• Arizona
• Arkansas
• Delaware
• Florida
• Georgia
• Hawaii
• Illinois
• Indiana
• Iowa
• Kansas
• Louisiana
• Michigan
• Mississippi
• Missouri
• Montana
• Nebraska
• New Hampshire
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Oregon
• South Carolina
• South Dakota
• Tennessee
• Texas 
• Utah
• Virginia
• West Virginia
• Wisconsin
• Wyoming
  

States with Different OEP Dates

Some states with their own ACA exchanges have different date ranges for the 2025 Open Enrollment Period. The chart below shows the State Enrollment Period (SEP) and OEP dates for these states; other states have not yet announced their dates (these are also listed below).

Looking For Affordable Health Insurance?

The health insurance 2025 Open Enrollment Period is open from November 1 until January 15 (depending on your state), so now is the perfect time to reconsider getting a health insurance plan, or looking into your current one and making sure it’s got you covered. And if your plan doesn’t cover everything you need it to, it’s time to find a plan that does, so you can save as much money as possible. 

If you’re shopping for a plan, your best bet is to speak to a licensed EZ agent. Our agents work with the top-rated insurance companies in the nation, so we can compare plans in minutes. We will not only find a plan that has all the benefits you’re looking for, but we will also make sure the plan meets your financial needs. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local agent, call 888-694-0047. No obligation.

Luckily, you won’t have to feel alone during this OEP, because EZ.Insure is here to help! EZ.Insure makes the enrollment process stress-free and simple. Our easy-to-use platform provides free quotes and side-by-side comparisons of all the available health plans in your area. We also have a team of dedicated agents who are always on hand to help guide you through the process or answer any questions, so you can leave feeling confident in your coverage. To help you feel even more prepared, we’ve compiled a brief list of helpful tips so you can tackle this OEP with ease.

1. Choose an Unbiased Agent

Who you choose to work with when looking for a health insurance plan is a very important decision, and plays a big part in finding a comprehensive, affordable plan. It’s important to work with a licensed, knowledgeable agent who is not connected to a certain type of health insurance plan or insurance company, so you can get an unbiased look at all available options in your area. 

EZ’s agents work with the top-rated health insurance companies in the nation, and we guarantee that we will compare all plans in your area so that you can find the perfect plan. And not only are our agents independent, but they are also always up-to-date on newer healthcare plans, so they can provide you with all the information that you need before you make your decision.

2. Consider ALL of Your Options

After choosing to work with an EZ agent, you can simply ask them to research every option that you have, as well as help you weigh all the pros and cons of each plan. There are many different types of healthcare plans available, including PPO plans, HMO plans, or metal tier plans; if you’re not sure what’s best for you, an EZ agent will go over all of these different plan types, and will not try to limit you to a certain plan. We will lay all of your options on the table and review the coverage and cost of each one.

3. Ask the Right Questions

When it’s time to start searching for plans, think ahead of time about what you want to ask your agent, and what is important to you in a plan. In addition to asking about prices and coverage options, have a list of questions you want to ask, like: 

• Is advanced primary care included in the plan?  
• Can you keep your current doctor? 
• Do you qualify for subsidies for any of the plans? 
• Can you see doctors outside of your network?
• Is mental health care (or anything else you’re interested in having covered) covered?
• Is a higher deductible or lower premium plan better for you?

4. Find the Plan That Has the Most Value

People often choose the cheapest plan available, but this cheapest plan might not have the best benefits available for the price. A good health insurance plan will come from a quality carrier, provide comprehensive benefits, allow you to see the doctors you want to see, and have affordable co-pays. And remember, if you go for the cheapest plan available, you might end up paying more out-of-pocket when you use medical services. Our agent will review your medical needs and budget, and search for a plan that will check all the boxes for you.

Need Help? EZ’s Got You Covered

The health insurance Open Enrollment Period will be open from November 1st through January 15 (depending on your state), so now is the perfect time to reconsider getting a health insurance plan, or to look closely at your current one to make sure it will cover all of the above-mentioned costs. And if your plan doesn’t cover everything you need it to, it’s time to find a plan that does, so you can save as much money as possible. 

If you’re shopping for a plan, your best bet is to speak to a licensed EZ agent. Our agents work with the top-rated insurance companies in the nation, so we can compare plans in minutes. We will not only find a plan that has all the benefits you’re looking for, but we will also make sure the plan meets your financial needs. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local agent, call 855-677-0157. No obligation.

And when it comes to deductibles, you actually have choices. You can choose a high-deductible health plan (HDHP) or a low-deductible health plan (LDHP). But what’s the difference between these types of plans?  This article will guide you through the specifics of HDHPs and LDHPs. As well as how to determine which type of plan will serve your needs most effectively based on your needs.

High Deductible Health Plans

A high deductible health plan (also known as a HDHP). As the name implies, is a type of health insurance policy that has a higher annual deductible than other types of healthcare plans. This difference can even be in the four-figure range. Meaning that you will most likely have to pay thousands of dollars out-of-pocket for medical care before your plan will begin to cover any expenses. 

With that being said, monthly premiums for these plans tend to be lower than for other plans. And you will still have routine preventive care covered in full before you meet your deductible. As with any ACA-approved plan. The actual deductible you will have if you choose a HDHP will vary depending on your plan and insurance company, but there is a minimum deductible amount for a plan to be considered a HDHP, which changes each year. For 2023, the minimum annual deductible for individuals is $1,500, while the minimum for families is $3,000.

Advantages of HDHPs

As mentioned above, if you choose a HDHP, you will have a plan with a high deductible. But lower monthly premiums. This means that if you know that you will most likely only use the plan for preventive care rather than more extensive medical treatment. You could save money by going with a HDHP. 

Other than lower monthly premiums, there is one other big advantage to HDHPs. You can open a health savings account (HSA) in conjunction with a HDHP; in fact, in order to have an HSA, you must have a HDHP. HSAs can be a great way to help pay for your out-of-pocket medical expenses. They are tax-advantaged accounts that can be used to pay for qualified medical expenses that your plan doesn’t pay for. Such as acupuncture and dental expenses. Your contributions to your health savings account are not subject to income tax. And they can be used to reduce the overall cost of your high deductible.

Disadvantages of HDHPs

The high cost associated with these plans is the most significant and obvious disadvantage of HDHPs. If you have a higher deductible, it means that you are responsible for paying a greater portion of your healthcare costs out-of-pocket before your plan begins to contribute. This may put a significant dent in your financial resources. Particularly if you are forced to deal with unanticipated problems relating to your health.

Low Deductible Health Plans

One of the most significant differences between a HDHP and a LDHP is that a low deductible plan typically has a lower deductible. But a higher monthly premium payment.

Because of their lower deductibles, this type of plan is typically chosen by people who see their doctor more regularly. And who need more medical care.  If this is the case for you, you might find that the higher amount you’re paying in monthly premiums is balanced out by the low deductible, since once you meet this lower amount, your insurance company will take care of your remaining costs. That could mean you’ll actually end up paying less out-of-pocket. In addition, LDHPs do not qualify for a health savings account (HSA), which is another difference between the two types of plans.

Advantages of LDHPs

Having a plan with a low deductible means you’ll have less to pay out-of-pocket if you need to access healthcare services more frequently, or if you have a true emergency or a catastrophic illness or injury, both of which can be very expensive. People who are older or who have a medical history that includes chronic conditions or illnesses may find that selecting a plan with a low deductible is the better option for them. Others who might benefit from this type of plan include:

• Women who are pregnant or who have the intention of becoming pregnant
• People who undergo a variety of specialized treatments or need expensive medications, such as those with cancer or on dialysis
• Any individual who is contemplating undergoing a surgical procedure within the next year

Disadvantages of LDHPs

Plans with low deductibles tend to have higher monthly premiums, since insurance companies will only cover a greater percentage of your care if you pay a higher premium. These premiums can feel like a burden each month, and if you don’t end up using your plan as often as you thought you might, you could start to feel like you’re wasting money.

Who Should Choose a High Deductible Health Plan?

As we pointed out above, a HDHP might be a good choice for you if you are healthy and anticipate having few to no healthcare expenses. In these circumstances, the lower monthly premiums that you would be paying for your “just in case” plan (which will also cover your preventive care), would save you money over a more expensive plan.

In addition, if you can’t afford a low deductible health insurance plan, you can still get yourself at least some level of coverage with a HDHP. And it’s important to have a plan, even if it has a high deductible, because health insurers negotiate rates with providers. This means you will pay less overall for products and services related to your health if you have health insurance than if you do not have health insurance. 

In addition, your high-deductible health plan (HDHP) will pay for necessary medical care, such as preventive services, if you purchase the plan on the individual market. But even if you have enough money to pay for a low deductible health plan, it may be worthwhile to consider a high deductible health insurance plan. Remember that if you have a high deductible health plan (HDHP), you can help to offset your out-of-pocket expenses with a health savings account (HSA).

Who Should Choose a Low Deductible Health Plan?

Again, a health insurance policy with a low deductible is likely to be beneficial to you if you are an older person, if you are not in good health, if you have a chronic condition. If you are planning to start a family, or if you simply make frequent use of your health benefits.

If you have costly health issues, purchasing a LDHP could save you money over the course of the year. Even with the higher premiums. If you switched to a HDHP, the amount you would save in premiums would be a much smaller fraction of the total amount you would pay in deductibles with your HDHP. And, frankly, many individuals find that it is simpler to pay a slightly higher amount on a monthly basis as opposed to a much larger sum all at once. Getting a low deductible health insurance plan might be the best choice for you if you don’t want to deal with the stress of potentially expensive medical care.

How to Choose

It is difficult to make a direct recommendation for a plan without knowing your unique financial situation and your health status. But we can offer the following advice to help you make a decision. Your best bet, though, is to speak to an EZ agent. Who can take your specific circumstances into account and find the best plan for you.

1.Look for discounts

 You might be eligible for assistance with your monthly premiums or cost-sharing expenses, depending on your income. So, before you write off a type of plan as too expensive. Ask an EZ agent if you qualify for subsidies or tax rebates.

2.Narrow down your choices

Think about the maximum amount of money you are willing to spend each month on your premium and go from there.

3.Look at additional features

When it comes to shopping for health insurance, deductibles are just one of many factors to take into account. Consideration should also be given to the size of the plan’s network, out-of-pocket maximums, and the structure of the plan. As well as the types of costs that are covered. After you have made a comparison of your expected medical costs for the year with the coverage options available to you. Look more closely at the plans you are considering. Ensuring that they provide the appropriate type of coverage for the amount of money you anticipate spending on healthcare.

4.Set your priorities

Your choice between a high deductible plan and a low deductible plan may come down to what you value more. The ability to save money on premiums if you are fortunate enough to not have many medical expenses. Or the peace of mind that comes from knowing that you won’t have to pay a deductible if you do end up needing more medical care. Doing some number crunching before making your decision might make things simpler for you.

Let EZ Help You

Do you need assistance comparing different plans and choosing the one that is best for your budget and healthcare needs? EZ.Insure is here to help! We will connect you with one of our dedicated, highly trained agents. Who will discuss all of your options with you and assist you in selecting the insurance policy that meets your needs, all at no cost to you. That’s right, there are no hidden fees associated with any of our services. EZ.Insure makes the entire process simple, easy, and quick. To get started, simply enter your zip code in the bar below. Or you can speak to an agent by calling 877-670-3557.

Premiums

Like a Netflix or Spotify subscription, premiums are a monthly payment you make to maintain a service. In this case your health insurance plan. If you purchase an individual plan on the Health Insurance Marketplace, you will pay your premiums in their entirety. But you might be eligible for subsidies or tax rebates. If your employer offers a group health plan, the cost of your health insurance premiums may be partially or entirely covered by your employer.

How much you pay in premiums will vary based on several factors. Such as the policy you choose, the number of people in your family, and the insurance company you go through. In addition, when determining your premium, insurance companies may take into account factors such as your age, where you live, and whether or not you smoke cigarettes. For instance, because healthcare costs are assumed to increase with age, premiums for older adults are higher.

Individual vs. Family Health Plan Premiums

Premiums for individual health plans and family health plans function in the same way. There is only one payment required each month, so the cost itself is the only difference. The cost of your premium will be higher the more people who are covered by it. But, if you do the math, you might find that you’re paying less per person for a family plan than you would if you all had your own separate plans. 

The only time this might not be the case is when someone in your family has significant health issues and another person rarely sees the doctor. In this case, it might be better to find plans that have lower premiums and higher deductibles for the healthier family member. And a plan with higher premiums and a lower deductible for the family member who needs more medical care. Let’s see why by taking a closer look at how deductibles work. 

Deductibles

In most cases, your insurance plan will have an annual deductible. Which you will have to meet before your health insurance begins paying for any of your medical care costs.  “Meeting” your deductible means that you will have to pay that amount in covered expenses to get coverage for anything other than preventive care. So, if your plan has a $2,000 deductible, for example, you’ll have to pay $2,000 out-of-pocket for things like lab work, minor surgeries, tests done at your doctor’s office, etc., and then your insurance plan will begin covering those things. 

There are a variety of ways deductibles can work, and which medical expenses will count towards meeting them. Health insurance policies for individuals and families may include a deductible structure. In which the insurance company is not obligated to pay for services until the deductible has been met. But in some cases, a plan may cover some medical expenses before the deductible is met while excluding others. In addition, certain expenses like copayments won’t count towards your deductible.

Individual vs. Family Deductibles

Health insurance deductibles can either be applied per person or per family. The way individual deductibles work is fairly straightforward, while family deductibles can be a bit  more complicated.

• Individual – First, the easy part. If you have an individual health insurance policy, the money you spend on qualified medical expenses will count toward meeting your deductible. Once your plan’s deductible is met, you and your insurance company will begin dividing the remaining costs. Meaning you will pay what’s known as “coinsurance,” or a certain percentage of each bill. You’ll do this until you reach your policy’s out-of-pocket maximum.
• Family – This is where things can get confusing, because your plan might have both an individual deductible and a family deductible. There are two main categories of family deductibles: embedded and aggregate. An aggregate deductible works the same as an individual deductible. Your plan will have one deductible, and everyone on the policy will be paying towards it. 

Embedded deductibles, though, is where the confusion sometimes comes in. With an embedded deductible plan, there is both a family deductible and an individual deductible. So, each member of the family has a separate deductible in addition to the family’s deductible. Once a family member’s deductible is met, the insurance policy begins covering 100% of that person’s healthcare costs. Everyone else in the family will still have to meet their own deductible after that member’s deductible is met. 

In addition, there is also a family deductible with these plans. And all family members will begin to have their expenses covered once the family deductible is met. Everyone will have to only pay their coinsurance until the out-of-pocket maximum is reached, once the family deductible is met.

Costs

The cost of your premiums and the amount of your deductible will depend on a variety of factors. It is difficult to give an accurate estimate of what you’ll pay without knowing your unique circumstances. Wut we can say that the average monthly premium price in the country is $456 per month. 

Check out our state-by-state health insurance guides to learn more about how the health insurance market is regulated in your state. And to get a baseline estimate of the costs. You can also learn more about the health insurance plans that are available in your state. As well as ways to reduce the cost of your coverage.

As for deductibles, the average nationwide deductible amount depends on the metal tier you choose for your plan: Bronze, Silver, Gold, or Platinum. Keep in mind, lower deductibles mean a higher premium.

The average annual deductible amount for each tier is as follows:

• Bronze – $7,482
• Silver – $4,890
• Gold – $1,650
• Platinum – $745

How Premiums and Deductibles Work Together

Insurance premiums and deductibles are interrelated costs. Your plan’s premiums will be higher if the deductible is lower, for example. So, generally, your plan will either have a higher monthly premium with a lower deductible, or a lower premium with a higher deductible.  

If you’re wondering which type of plan would be better for you. Consider that a higher premium with a lower deductible would be more appropriate for someone who has a pre-existing condition and needs to see the doctor frequently. And if you don’t often see the doctor or generally spend a lot on medical services, having a higher deductible won’t be as much of an issue for you. And you might be better off spending less on your premiums.

FAQs

• How can I lower my premiums?

If you have individual coverage, and your household’s annual income is less than or equal to 400% of the federal poverty level, you might be eligible for subsidies or tax rebates. Which can lower the price of your premiums. If you have group health insurance through your employer, they might offer you reduced health insurance premiums or other incentives if you are able to meet certain health and wellness criteria.

• What will increase my premiums?

Your health insurance premiums may increase for a variety of reasons. Including but not limited to inflation, adding family members to your plan, and relocating to an area with a higher cost of living. It’s also possible that your monthly health insurance premiums will go up if you opt for a plan with more generous benefits. Consider the policy’s premium in light of its benefits before making your decision.

• Are premiums tax deductible?

If you have a plan through either the federal or state Health Insurance Marketplace, your premiums are tax deductible. If you’re self-employed, health insurance premiums are tax deductible. And you may also be able to deduct the premiums you pay for long-term care insurance. Before submitting a tax deduction claim, you may want to consult a tax expert.

• Is a high or low deductible plan better for me?

If you do not anticipate having many medical expenses during the next plan year, selecting a health insurance policy that has a high deductible could give you the best value. When you anticipate having a lot of medical expenses in the near future, such as if you plan on having a baby, selecting a plan with a low deductible could help you get the most value out of your coverage.

• What does “no-charge” deductible mean?

If you have a plan with a “no-charge” deductible, your plan will pay 100% of eligible medical expenses after you meet your deductible for the year.  No-charge deductibles tend to be higher. But if you plan on using a lot of medical services for the year, it might balance out when you are no longer required to pay anything out-of-pocket.

How EZ Can Help

EZ.Insure provides access to local, highly trained insurance agents. Who will shop around for the best policy at the most affordable price. We can save you hundreds of dollars a year by searching both on and off the Marketplace for a plan that fits your needs. We can also find out if you’re eligible for any local discounts. And then apply them to your plan for you. And the best part is that we do all of this for free! To find out how much you could be saving, simply enter your zip code on the box below for free, instant quotes. Or call us at 877-670-3557 to speak to an agent who can answer all of your questions and find you the perfect plan.

With that being said, having two plans can also mean paying twice as much each month for your premiums. As well as twice as much for your deductible. So if you are considering purchasing additional coverage, you’ll need to give serious thought to whether or not enrolling in a second health insurance plan would be the best option for you.

To help you make this decision, we’ve broken down how primary and secondary insurance policies work. So you can understand the difference and get a better idea of how two policies could work for you. And, as always, if you have any questions, or need help looking for the right policy – or policies – for you, contact an EZ agent!

Primary Insurance

Your primary plan will be the plan that will first cover any necessary medical care. This plan will pay before your secondary insurance plan kicks in. For instance, if you need to see a doctor or buy prescription drugs, your primary insurer will cover the costs of these services up to the coverage limits that it provides. Remember, though, as with any health insurance plan, you may still be responsible for cost-sharing, like coinsurance.

Secondary Insurance

In most cases, if you have a secondary insurance plan, it won’t begin to pay out benefits until after your primary insurance plan has exhausted its available coverage. After your primary insurer has paid its share of your medical costs, your secondary plan will begin to take effect to cover any additional costs that remain.

How to Get Two Plans

Getting secondary health insurance is similar to getting primary health insurance, but there are some differences to keep in mind. Here are the steps to getting a second policy:

1. Assess your primary policy – Review the policy documents for your current plan to find out what services are covered, how cost-sharing works, and what coverage limits there are. Think about your current and future health needs to find any gaps in your coverage. 
2. Research secondary options – Options for secondary coverage range from plans that cover just one type of health service to plans that cover everything. Find out what kinds of plans are available to you and choose the one that fills in the gaps in your current coverage the best.
3. Understanding coordination of benefits – People can’t choose which of their two health plans is the “secondary” one. Before you sign up for another plan, make sure it will pay after the one you already have. 
4. Apply and purchase – To sign up, follow the instructions for the plan you’ve chosen. Fill out the forms carefully and be ready to answer questions about your current health insurance. Pay your first month’s premium after getting approved for coverage.

How Does Having Two Plans Work?

When you have a medical bill, the first insurance that pays out is your primary insurance. It will pay up to its coverage limits. Then your secondary insurance will kick in and can pay part or all of the remaining costs. Please be aware that there are limits to the coverage provided by both the primary and secondary insurance. If the secondary insurer does not pay in full, the remaining balance will be your responsibility. Therefore, it is possible that you will have some remaining out-of-pocket medical costs. Even if you carry multiple health insurance policies. 

There is a good chance that a Coordination of Benefits clause is included in your health insurance policy. This clause will lay out the predetermined order of how your plans will pay for your covered services. So, in the event that you or your medical provider file a claim for your care, the Coordination of Benefits document will specify which plan is accountable for making payments. 

Examples of Primary and Secondary Plans

So, if you have more than one insurance policy, which policy is considered primary and which is considered secondary will be determined by your circumstances. The following are some examples of how primary and secondary plans work for different groups of people:

• Married Couples – Say a wife has her own insurance but she is also covered under her husband’s group insurance from his job. The wife’s primary insurance would be her individual plan and her husband’s group coverage would be the secondary.
• Minors under 26 – Under the Affordable Care Act, dependents can remain on their parents’ insurance until age 26. This means that an adult under this age could get their own health insurance policy from their employer while still being covered by the family policy. If that’s the case, the child’s health insurance would be the primary plan. And the parent’s would be the secondary plan.
• Parents with separate plans – Say you are under 26 and still on your parent’s health plan. If they both have separate plans and you’re listed on both of them, you have dual coverage. The primary and secondary coverages are determined by a “birthday rule”. Meaning whichever parent’s birthday is earlier in the year will give you your primary insurance. And the one with the later birthday will give you your secondary plan. For example, if your mom’s birthday is in January and your dad’s birthday is in March. Your Mom’s insurance would be your primary coverage. This isn’t about which parent is older – the birth year doesn’t affect the order, only the birth month.
• Medicare beneficiaries with group health plans – If you are 65 or older and on Medicare, but are still working and have insurance through your employer, Medicare will be your primary insurance if the company you work for has fewer than 20 employees. If your company has 20 or more employees, your group plan will be primary and Medicare will be secondary.

Out-Of-Pocket Costs

The cost of having two plans will generally be higher than the cost of having one plan. Since you will have to pay the premiums and deductibles for each of your health insurance policies. For example, consider this: you will not be able to use your secondary coverage to cover your primary’s deductible. You will also have to pay any copayments and coinsurance that are associated with each plan.

It’s also important to note that the rules of your primary plan will apply to both of your policies. So, for example, if your primary plan is a PPO plan. Your primary policy may stipulate that you can only use certain doctors and hospitals in your plan’s network. Your primary insurance won’t pay anything if you go to a doctor who isn’t in their network. The secondary insurance won’t either because you broke the primary plan’s rules by going to an out-of-network doctor.

In addition, if your provider charges you more than what your plan(s) considers to be reasonable, customary, or allowed under plan rules, you may have to pay the difference. A licensed insurance agent from EZ can help you understand the out-of-pocket costs associated with each of your plan options.

Weighing Your Options

There are positives and negatives associated with choosing to have a primary and secondary insurance plan. Just as there are with any other type of insurance. Let’s take a look at the pros and cons to help you decide if having two plans might be right for you.

Benefits

• Extra Coverage – Having two plans could come in handy in the case of unanticipated medical expenses. And if you find that you frequently have to pay for your own medical expenses out-of-pocket, it may be beneficial to purchase a secondary health insurance policy.
• No Gaps – Even if one of your health insurance policies lapses, you won’t experience a gap in coverage if you have a second plan. Your secondary health insurance will just become your primary automatically.
• Complementary coverage – Having plans that are complementary, that cover different elements of your healthcare, will mean you’ll get more coverage and better benefits. You’ll be able to make up for what your primary health insurance doesn’t cover with your secondary plan.

Disadvantages

• No guarantee – Even if you have two separate health insurance policies, your out-of-pocket costs may still not be covered in full. Keep in mind that the amount of your plans’ coverage cannot be more than the amount of your out-of-pocket expenses.
• Extra expenses – Your two separate health insurance policies will still require you to make payments on the associated premiums and deductibles. This may result in additional expenses further down the road.
• Overlapping – It’s possible that your coverage from two different health insurance plans will actually overlap if the plans are too similar to one another. Meaning you will not receive as many additional benefits as you might like.

FAQs

• What is the birthday rule?

When children are covered by both parents’ health insurance policies, the birthday rule plays a significant role in determining which plan provides primary coverage and which provides secondary coverage. According to the birthday rule, whichever parent’s birthday falls earlier in the year will be the primary insurer. Secondary insurance is provided by the other parent’s plan. The year of birth of each parent does not come into play.

• How do I know which is my primary insurance?

You don’t get to choose which plan will be your primary coverage and which will be your secondary coverage. Whenever you file a claim, your primary health plan will cover you as if you didn’t have a secondary plan. After that, your secondary health insurance will cover the rest of the bill. If you have two health plans, there are rules about how your benefits will work together. Some of these rules will be different for you based on your health insurance company and your situation.

• Is having 2 plans worth it?

It depends. Having two health plans can save you money if one is free or both are inexpensive. Also, it’s best to make sure they work well together. Check to see if their coverages and benefits overlap or are too similar.

EZ Is Here to Help

Having both primary and secondary coverage can be complicated. It could work for you, but you’ll need to weigh the pros and cons carefully before deciding whether or not to invest in a secondary insurance policy. Feel free to ask EZ anything. Including if having two plans might be right for you, as well as for assistance in locating a secondary health insurance plan, if necessary. We will compare plan benefits and costs for you. And will assist you in locating affordable coverage that meets your needs. Simply enter your ZIP code below to get started with free, customized quotes right now! You can also give us a call at 877-670-3557 to have a qualified insurance professional discuss your needs and help you choose the best policy for you.

Actual Charge

This is the dollar amount that is charged by a doctor or other healthcare provider for a particular medical service or treatment. 

Actuary 

A person that is trained in the mathematical and statistical aspects of the insurance industry. They are the ones who calculate premium rates and assist in estimating the costs and savings of your health insurance plan.

Allowed Amount

Also sometimes called an eligible expense, a payment allowance, or negotiated rates, an allowed amount is the amount that your insurance company is willing to pay for a covered healthcare service. If your provider charges more than the allowed amount, you might have to pay the difference. 

Balance Billing

This is a bill for the amount that you owe for a particular service after insurance has paid its share – in other words, the difference between the actual charge and the allowed amount. For example, if your provider charges you $200 for a service, and the allowed amount is $100, your provider will most likely bill you for the remaining $100. 

Coinsurance

This is your share of the cost of a covered healthcare service, calculated as a percent of the allowed amount for the service. You generally have to pay the coinsurance plus any deductible that you owe. For example, if your health insurance plan’s allowed amount is $100 for an office visit and you’ve met your deductible, your coinsurance payment of 20% would be $20 for the visit.

Co-pay

This is a fixed amount you pay for covered health care services, such as visits to your doctor, specialists, or any other health care professional. Your co-pay will vary depending on the type of covered healthcare service you receive: visits to a primary care physician, specialist, and the emergency room will all be priced differently.

Deductible

This is the amount you have to pay each year in medical expenses before your health insurance will kick in and begin to cover the rest of the year’s medical expenses. For example, if your deductible is $2,000,  your plan will not pay anything until you have met your $2,000 deductible for covered healthcare services. 

Drug Formulary

A list of prescription medications that are selected for coverage under a health insurance plan. Prescription drugs can be included on a drug formulary based on their efficacy, safety, and cost-effectiveness. Some plans will place medications on different tiers, which will change the price of the medications. Some health insurance plans may require that patients obtain preauthorization before non-formulary drugs are covered.

Durable Medical Equipment

If you need any medical equipment, such as crutches, oxygen apparatus, wheelchairs, or even blood testing strips for diabetes, your health insurance plan will most likely cover the cost of these things up to a certain point. Generally, you will have to pay coinsurance for any durable medical equipment that you receive. 

High Deductible Health Plan (HDHP)

This type of plan has lower monthly premiums, but a high annual deductible. These plans are generally aimed at people who are healthy and do not go to the doctor often, and so do not expect to have to meet the high deductible. 

In-Network Vs Out-of-Network

If a healthcare provider is in-network, that means your health insurance plan will cover services provided by them. These are very important terms to know, because if you seek services from a healthcare professional who is considered out-of-network by your plan, you might have to pay for the service completely out-of-pocket. 

Out-of-pocket Limit

This is the most that you will have to pay for medical services during a policy period, which is usually a calendar year. Your premiums and most other medical expenses paid out-of-pocket will count towards your limit, but you should be aware that some plans will not count co-payments, deductibles, or coinsurance, so it’s important to check your policy. 

Premium

The amount that you will pay for health insurance every month. Your premium does not include any other expenses. If you do not pay your premium, you will lose your health insurance coverage. 

Specialist

A healthcare professional that specializes in a certain condition or area of the body. Specialists include gastrologists, dermatologists, and podiatrists, for example. Seeing a specialist will cost more than seeing your primary care physician, so your co-pays and actual charges will be higher. 

UCR (Usual, Customary, and Reasonable)

This is the amount charged for a medical service within a specific geographic area, based on what providers in the area usually charge for the same or similar medical service.

The best way to understand how health insurance works, and to find the right plan for you and your family’s specific needs, is by working with an agent who specializes in health insurance. EZ can help: we offer a wide range of health insurance plans from top-rated insurance companies in every state. And because we work with so many companies and can offer all of the plans available in your area, we can find you a plan that saves you a lot of money – even hundreds of dollars – even if you don’t qualify for a subsidy. There is no obligation, or hassle, just free quotes on all available plans in your area. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local agent, call 855-677-0157.

What Types Of Plans Are Available?

There are a lot of plans – and we mean A LOT – of different plans out there to choose from. There are metal tier plans, HMOs, PPOs, POSs, EPOs, and more. Each plan offers different levels of flexibility, coverage options, and rates; your available options also depend on where you live, so be sure to ask your EZ agent which plans are available in your region. We will gladly go over every single option and discuss the difference between each plan, so we can help you determine which one is right for you and your family.

What Are The Metal Tiers?

Health plans available on the ACA Exchange are separated into four metal tiers. These tiers do not indicate the level of care you will receive; rather, the tiers let you know how much you will pay for care and how much your insurer will pay. The tiers are:

• Bronze– Lower monthly premiums, but a higher deductible and copays. You will usually pay an average of 40% of costs of care, and your insurer will pay 60%. 
• Silver– Moderate monthly premiums and moderate medical costs. You will pay 30%, and your insurer will pay 70%.
• Gold– Higher monthly premiums with lower out-of-pocket costs. You will pay 20% and your insurer will pay 80%. 
• Platinum– Highest monthly premiums and lowest out-of-pocket costs. You will pay 10% and your insurer will pay 90%. 

We will be able to go over this in more detail, including what each type of plan will cover and how much you will pay, so you can have a better understanding of how these plans work.

Can I Add Supplemental Insurance?

Dental and vision are considered supplemental insurance plans; some health insurance plans do not offer these, so you will have to ask if they are part of the plan you are looking into. If they are not, we can help you find affordable dental and vision plans. 

What is A HDHP & Will It Work For Me?

High deductible health plans are exactly what they sound like: these plans have high deductibles, but in exchange, you will have low affordable monthly premiums. These plans are generally for healthy people who only see the doctor for annual physical exams and do not have any chronic conditions that require constant medical attention, and who will most likely not have to pay their whole deductible. For 2022, the Internal Revenue Service has defined a HDHP as any plan with a deductible of at least $1,400 for an individual, or $2,800 for a family.

How Are Medications Covered?

Figuring out the cost of your prescriptions can be a little complicated since different insurance companies can charge differently for the same drug – some drugs might even be covered differently by the same insurer depending on the plan you choose. Basically, insurers put medications into  a drug formulary, which is divided into four tiers:

1. Tier 1– Inexpensive generic drugs
2. Tier 2- Brand name drugs and more expensive generic drugs
3. Tier 3– Non-formulary drugs, generic or brand name
4. Tier 4- Specialty drugs

To find out which plans cover your medications and how much you will be charged based on their placement in the insurer’s drug formulary, you need to speak with an EZ agent. We will review each plan available in your area and their drug formularies to make sure that your medications are covered, and that they will not cost you an arm and a leg. 

What About Out-of-Network Coverage?

Some plans, like HMOs, will not cover out-of-network coverage, but PPO and POS plans do cover out-of-network coverage in case of an emergency. If you travel or visit family in other parts of the country often, you’ll definitely want to consider a plan that covers out-of-network emergencies; otherwise, if you have an accident while away from home, you could be stuck with a bill that you have to pay out-of-pocket.  

Do I Need Referrals?

With some plans, you’ll need a referral from your primary care physician (PCP) to see a specialist, like a gastroenterologist or an orthopedic doctor. If you want to skip this step and see a specialist whenever you feel necessary, we can help you find a plan that does not require a referral. You’ll have more flexibility with a plan that doesn’t require referrals, and you won’t have to pay a PCP copay just to get a referral to see a specialist.

There are so many things to think about when looking for a health insurance plan for you and your family. Do you want more flexibility? Supplemental insurance? Cheaper prescriptions? The easiest way to find the right plan for you and get the answers to these questions is to work with an EZ agent. We will compare plans, go over every option, discuss your needs, and help you sign up for the plan you need, all at no cost to you. Our services are completely free, with no hassle and no obligation. Speak to an EZ agent now, before the OEP ends! Get free health insurance quotes by entering your zip code in the bar above, or to speak with a local agent, call 855-677-0157 

What The ACA Has Done for Millions

Before the ACA was passed in 2010, you could have been denied a health insurance plan simply because you had a pre-existing condition. That meant a huge amount of Americans were unable to find affordable health insurance: approximately 43% of U.S. households report having pre-existing conditions. And indeed, health insurance was out of reach for many before 2010: when the ACA went into effect approximately 46.5 million people, or 17.8% of the total nonelderly population, were uninsured. 

But the ACA, with its Patients’ Bill of Rights that prohibits insurers from discriminating based on pre-existing conditions or revoking your coverage because of an unintentional mistake on an application, changed everything. 31 million people have enrolled in health insurance plans through the Affordable Care Act since it was enacted, and that is a huge accomplishment! But there has been criticism over the years that health insurance, while available to everyone, was still not accessible to everyone – but that has all changed. 

President Biden’s American Rescue Plan

 save afcad

Earlier this year, President Biden passed the American Rescue Plan (ARP), which has made health insurance far more affordable for far more people. It extended premium tax credits to more Americans by allowing people who earn over 400% of the federal poverty level to receive subsidies to purchase health insurance through the ACA Marketplace; it also requires that Americans pay no more than 8.5% of their income on health insurance premiums, and provides a larger tax credit to people who already receive financial assistance.

What all of this means is cheaper premiums! For most people, premiums will be at least $50 per month cheaper, while some people might pay $0 in premiums. With the new law:

• An individual making $19,000 or less per year will not have to pay a monthly premium for health insurance. 
• Couples who earn less than $70,000 together will save $1,000 per month on their health insurance monthly premiums. 
• A family of 4 with an income of $90,000 will pay about $200 less in health insurance premiums.

The bottom line is you can never be denied health insurance coverage during the Open Enrollment Period; not only that, but insurance is now affordable for everyone, so there is no reason you can’t get a plan that is right for you. It is important to note, though, that the Open Enrollment Period is the only time you will be able to get coverage: if you miss the OEP, you will have to wait until next year’s OEP, unless you qualify for a Special Enrollment Period. Don’t let this period pass you by – it’s the perfect (and only) time to get a great affordable health insurance plan!

Need Help?

If you have any further questions, or need help finding a plan during the Open Enrollment Period, an EZ agent can help you. We will provide you with a local licensed agent who will search all available plans in your area and find the best one for your medical and financial needs. We will also double check to see if you qualify for any subsidies to save you even more money. All of our services are done in minutes and at no cost to you. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local licensed agent call 855-677-0157.

You Could Get Stuck With Your Current Plan

This might not necessarily be a bad thing if you are happy with your current plan, but if your plan isn’t quite right for you, you will unfortunately be stuck with it until the next Open Enrollment Period opens up again.

You’ll Miss The Opportunity To Change Your Plan

If you don’t take the opportunity to review your current plan and do nothing during the Open Enrollment Period, you won’t be able to change your plan. What this really means is that your health insurance might:

• Not provide enough coverage for the following year, which will cost you money.
• Have too much coverage that you don’t need, essentially leaving you to pay for insurance that you don’t need.
• Be too expensive. If you don’t change your plan during the OEP, you’ll be stuck with the rise in rates and costs for the following year. 

Options Are Limited Afterwards

If you don’t have health insurance and are looking to enroll in a plan, but you do nothing during the Open Enrollment Period, you won’t be able to get a Marketplace or exchange health insurance plan – in other words, you won’t be able to get an ACA-compliant health plan. With that being said, you do have other options even if you miss the OEP, but you should be aware that they are very limited. For example, you can opt to get a short-term health insurance plan that covers the essentials and nothing more; this type of insurance is temporary and not ideal for those who require more comprehensive coverage, or have health conditions. Short term plans are not guaranteed issue, meaning they do not cover pre-existing conditions.

You Will Need To Qualify For an SEP

The only way to get an affordable health insurance plan that is ACA-compliant outside of the OEP is to qualify for a Special Enrollment Period, or SEP. A Special Enrollment Period is only available to those who have a qualifying life event, including:

• Change in residence (moving to a different zip code or county)
• Change in household size (having a baby or adopting a child, getting married, or getting divorced)
• Loss of health insurance (losing employment, turning 26 and getting kicked off of a parent’s plan, or a death in the family)
• Changes in income

Don’t Do Nothing…

Compare plans! There’s no harm in comparing plans and seeing your options before the Open Enrollment Period ends. But we get that it can be a headache to try and research all the different plans around, so we’re here to help! Our highly trained agents will take the time to talk with you and thoroughly explain all of your options. Once you are ready to enroll, they will search through all the plans in your area and find the right plan for you, making sure the plan fits your needs and budget. EZ always provides you with your own personal agent, so there’s never any need to worry about bouncing around from agent to agent or getting hassled by endless sales calls. To get started, enter your zip code in the bar above, or to speak to an agent directly, call 855-677-0157.