Health insurance
Health coverage for the years before Medicare
Leaving a job, working for yourself, retiring early or simply comparing: we explain the coverage available to individuals and families under 65 so you can choose with a clear head.
Getting started
Coverage before 65 comes from a few places
If Medicare is not an option yet, your health coverage most likely comes through an employer, through the Health Insurance Marketplace, or through a plan you buy directly. Each has its own rules about who can enroll, when, and what it costs.
The numbers on a plan summary only mean something once you know how you use care. We start there, with your doctors, your prescriptions and your budget, and then compare the plans that fit.
Where coverage comes from
The main routes to coverage
Through an employer
Group coverage
Coverage offered by your job or your spouse's job, often with the employer paying part of the premium. When it ends, you usually have a window to continue it for a time or to choose something else.
The Health Insurance Marketplace
Individual and family plans
Plans sold through the Marketplace cover a standard set of essential benefits and cannot turn you down for health history. Depending on household income, help with the monthly premium may be available.
Plans bought directly
Off-Marketplace coverage
Some insurers sell individual plans outside the Marketplace. They can suit people who do not qualify for premium help, but the details vary, so the fine print matters.
What to compare
Six numbers that decide what a plan really costs
A low monthly premium can come with a high deductible, and the reverse. Looking at the whole picture is the only fair comparison.
Premium
What you pay every month to keep the plan, whether or not you use care.
Deductible
What you pay for covered care before the plan starts sharing costs.
Out-of-pocket maximum
The most you pay in a year for covered care. After that, the plan pays in full.
Copays and coinsurance
Your share of each visit, prescription or procedure once the deductible is met.
Provider network
Which doctors, hospitals and pharmacies are in the plan, and what happens if you go outside it.
Drug formulary
Which prescriptions the plan covers and at what tier. Bring your list; we check every medication.
Not sure which route applies to you?
Tell us where your coverage stands today and what is changing. We explain the options that fit, in plain language, and the decision stays yours.
Life changes
When your coverage situation changes
Most people shop for individual coverage because something changed: a job ended, a business started, a marriage or a move happened, or a child aged off a parent's plan.
Many of those changes open a Special Enrollment Period, a limited window to pick a new plan outside the yearly open enrollment. Knowing which events count, and how long the window lasts, keeps you from going without coverage.
Changes that often open an enrollment window:
- Losing coverage from a job, including through a layoff or retirement
- Getting married, divorced, or adding a child to the household
- Moving to a new county or state
- Turning 26 and leaving a parent's plan
Timing
When you can enroll
Individual and family coverage follows set windows, with exceptions for life events.
Marketplace Open Enrollment
The yearly window to enroll in or change a Marketplace plan for the coming year. For the federal Marketplace it runs from November 1 into mid-January; some state-run Marketplaces set their own dates.
Special Enrollment Periods
A qualifying life event such as losing other coverage, a move, a marriage or a birth usually opens a 60-day window to choose a plan. Documentation of the event is often required.
Employer coverage windows
Employers hold their own open enrollment each year and allow mid-year changes after qualifying events. When employer coverage ends, continuation coverage may be available for a limited time at full cost.
Approaching 65
In the months before 65, the question becomes how individual coverage hands off to Medicare. We plan that transition so there is no gap and no overlap you are paying for twice.
How we help
Five steps, at your pace
Step 1: Reach out
Call or send a message and tell us what you'd like to understand better.
Step 2: You talk, we listen
You describe where you are today, what worries you and what you hope to achieve.
Step 3: We explain
We walk through the options that apply to you, in everyday language, trade-offs included.
Step 4: You choose
With the facts in front of you, the decision is yours to make on your own timeline.
Step 5: We stay with you
Choosing coverage isn't the end. We remain available for questions, reviews and changes down the road.
Common questions
Health insurance questions we hear most
Can I be turned down because of my health?
Marketplace plans and most individual plans that follow the same rules cannot deny coverage or charge more because of your health history. Some other products, such as short-term plans, work differently and can ask health questions, which is one reason to understand exactly what you are buying.
How do I know if I qualify for help with the premium?
Premium help through the Marketplace depends on household size and expected income for the year, and the rules change from year to year. We can walk through an estimate with you, and the Marketplace confirms the final amount when you apply.
My job's coverage is ending. What are my choices?
Usually three: continue the employer plan for a limited time at full cost, choose an individual or family plan through the Marketplace during the Special Enrollment Period that losing coverage opens, or join a spouse's plan if one is available. Which is better depends on cost, your providers and how long you need the coverage.
What does it cost to work with Robert?
Nothing. Brokers are paid by the insurance companies, and the premium is the same whether or not a broker helps you enroll. You get someone to call when a bill or a letter makes no sense.
Not affiliated with or endorsed by the government or federal Medicare Program
Information on this site is general education, not personalized insurance, legal, tax or investment advice. Plan availability, premiums and benefits are set by insurers and Medicare and change each year.
Let's find coverage that fits
Call, send a message, or answer a few quick questions. We'll start with your situation and end with options you understand.