The questions people ask before they trust us

Nothing. There is no fee, no consultation charge and no retainer. We are compensated by the carrier whose plan you choose, and plan premiums are filed with the state, so the price is the same whether you enrol with us, over the phone with the Marketplace, or on your own at midnight.

Because we want the renewal and the referral, not the one-off. A client who buys the wrong plan calls us in March furious, cancels in April, and tells their friends. That is worse business than a smaller commission.

Yes. We are not captive to any single carrier. We hold appointments with the carriers listed on our carrier panel page and we compare across them. We do not represent every plan available in every area, and we say so plainly.

No. We collect what is needed to quote and enrol you and we do not sell it. The privacy policy spells out exactly what we hold and how long.

Your estimated household income is compared to the federal poverty level for your household size. That gives a percentage of income you are expected to contribute. The credit is the difference between that expected contribution and the cost of the second-lowest-cost silver plan in your rating area, which is called the benchmark plan.

To any metal level except catastrophic. The benchmark is a silver plan, but you can take the credit to bronze or gold. Cost-sharing reductions are different: those only attach to silver.

A silent upgrade to a silver plan for households under 250% of the federal poverty level. The plan's actuarial value rises to roughly 73%, 87% or 94% depending on your income band, which means a lower deductible and a lower out-of-pocket maximum for the same premium. Buy bronze instead and you leave it behind.

Report it to the Marketplace, ideally within 30 days. Your monthly credit drops, and you avoid repaying a year's worth of excess credit on Form 8962 at tax time. Repayment is capped at some income levels; above 400% of the federal poverty level it is generally uncapped.

No. Nothing updates itself. Report the drop and your credit goes up from the next available coverage month, which is money back in your month right away. You may also newly qualify for cost-sharing reductions, which would be a reason to move to silver.

Tennessee has not expanded Medicaid, so there is a coverage gap below the level at which Marketplace subsidies begin. We will tell you plainly where you fall and help you check TennCare and CoverKids eligibility rather than pretending a plan you cannot afford is a solution.

Gold pays a larger share of your care costs, which is not the same as being better for you. Metal level is a cost-sharing split. If you never use care, bronze wins; if you have a surgery scheduled, gold usually wins; under 250% of the federal poverty level, silver usually beats both.

It depends on the specific plan, not the carrier. Two plans from the same company can have different networks. We check the named practice, and we tell you when a plan would cost you your doctor.

We run each one, with the dose and quantity, against the plan's formulary. A drug on tier 4 in one plan can be tier 2 in another, and that difference outweighs most premium differences over a year.

Only with a qualifying high-deductible health plan. Most bronze plans qualify, some silver plans do, gold almost never does. It is a property of the exact plan, so we check the plan document rather than the metal colour.

A restricted plan available to people under 30 or with a hardship or affordability exemption. It covers the same essential health benefits with three pre-deductible primary care visits, but no premium tax credit can be applied to it. If you qualify for any credit, a subsidised plan almost always beats it.

November 1 to January 15 for Marketplace plans in Tennessee and Georgia. Enrol by December 15 for coverage starting January 1. Enrol between December 16 and January 15 and coverage generally starts February 1.

Only with a qualifying life event: losing coverage, moving, marrying, a birth or adoption, a change in income affecting eligibility, a change in immigration status, or release from incarceration. You get 60 days from the event.

No. It runs from the date of the event itself. For a planned loss of coverage you can often apply in the 60 days before it happens, which avoids any gap at all.

The Annual Enrolment Period is October 15 to December 7 with changes effective January 1. Medicare Advantage Open Enrolment runs January 1 to March 31 and allows one change. Your Initial Enrolment Period is the seven months around your 65th birthday.

If you are already receiving Social Security, usually yes for Part A and Part B. If you are not, nothing happens unless you act. That is the single most common expensive surprise we see.

Generally 10% of the standard premium for each full 12-month period you could have had Part B and did not, added to your premium for as long as you have Part B. If you delayed because of creditable employer coverage, keep the letter that proves it.

A genuine trade. A Supplement means any provider who accepts Medicare, no network, predictable cost, and a higher fixed premium. Advantage means a network, possible prior authorisation, extra benefits and a lower premium. We model both against your doctors and your drug list.

Because Advantage and Part D plans refile their benefits and formularies every year. The plan you liked in January can look different the next January. We re-run your list before December 7.

Generally two enrolling employees is the floor for small-group medical in Tennessee. Small group runs up to fifty full-time equivalent employees.

Carriers require a minimum share of eligible employees to enrol. Employees who waive because they have other coverage, such as a spouse's plan or Medicare, can usually be excluded from the calculation. That is how most borderline groups qualify.

An individual coverage health reimbursement arrangement. You set a defined monthly contribution per class of employee, they buy their own individual plan, and the reimbursement is tax-advantaged. Your cost is capped and employees get choice.

Employers with fewer than fifty full-time equivalent employees are not subject to the employer shared responsibility provisions. At fifty and above the rules change and we bring in the detail on thresholds and affordability.