The 10 Questions People Ask Me Most Before Open Enrollment

Most people only know about one door: the ACA Marketplace. If you’re self-employed, a 1099 worker, or a business owner, there’s another one.

Robert Peraino, Licensed Health Insurance Advisor · Streamline Healthcare

1. When do I actually have to decide?

With a private option, you don’t have to wait. You can apply any month of the year.

On the Marketplace, open enrollment opens November 1, and December 15 is the deadline for coverage starting January 1. Miss it and you are usually looking at February 1.

2. What if I just let my plan renew?

Private options are written with defined terms, so you’re not fighting a new rate every January.

On the Marketplace, renewing means you accepted next year’s premium, deductible, network, and drug list without reading any of them. All four change every year. Auto-renewing is a guess, not a decision.

3. My income changes every year. How do I estimate it?

With a private option, you don’t. Private plans price on your age and health, not your income. No income projection, nothing to pay back at tax time.

On the Marketplace you have to guess, and if you guess low you may owe part of your subsidy back. Have the best year of your life on a private plan and your rate does not move.

4. Can I get covered if I miss open enrollment?

Yes. Private options are open year-round. Missing the window does not mean going without.

On the Marketplace, usually only with a qualifying life event: losing coverage, moving, marriage, a new baby.

5. Will my doctor still be in network?

Before you apply for a private option, I check your doctors by name. No surprises after you enroll.

On the Marketplace, not automatically. Networks get renegotiated every year, and nobody calls to tell you.

6. Will my prescriptions still be covered?

Before you apply for a private option, we run your medication list against the plan’s benefit schedule together.

On the Marketplace, the drug list is rewritten every year. A medication that costs you ten dollars today can move tiers or come off entirely in January.

7. Why is the cheapest premium not the cheapest plan?

A private option gives you a price based on your age and health, not a number that depends on guessing your income.

Either way, the premium is only the part you see every month. What you pay in a year is the premium plus the deductible plus what you spend when you use it. The right comparison is total annual cost. That is the math I walk people through.

8. What if I work across state lines?

Private options are portable. Your coverage travels with you if you move or change jobs.

Marketplace plans are tied to the state you live in. If you drive a route, take contracts, or travel for work, this matters more for you than for almost anyone. Ask before you enroll, not after.

9. Do I make too much to qualify for help?

It doesn’t matter with a private option. It never looks at your income in the first place.

On the Marketplace, a lot of self-employed people earn past the subsidy range and end up paying full freight. It costs nothing to find out which side of the line you are on.

10. What does it cost to work with me?

Nothing, whether you choose a private option or a Marketplace plan. I am paid by the carrier, not by you.

The plan costs the same either way. What you get is somebody who reads the plan documents, checks your doctors and your prescriptions, and picks up the phone next March when you have a question.

Why Self-Employed People Look at Private Options

• Priced on age and health, not income.
• No income proof and no subsidy payback.
• Apply any month of the year.
• Portable across state lines.
• May be a business expense depending on how your business is set up. That’s a question for your tax professional.

Is it right for everyone? No. Private options are medically underwritten, and not everyone qualifies. Benefits are paid on a set schedule, and maternity, mental health, and substance use treatment are generally not covered. I’ll tell you straight when the Marketplace is the better answer for you.

Three Things to Have Ready Before You Call

• Your projected income for the coming year.
• Every medication you take, with the dosage.
• The doctors you want to keep.

Twenty minutes and we will know where you stand.

Call or text (815) 790-1190

Robert Peraino, Licensed Health Insurance Advisor

Streamline Healthcare