Health Insurance FAQ — Palm Beach County

Nothing. Insurance carriers pay the agent's commission. Your monthly premium is identical whether you enroll through an agent or directly with the carrier. There is zero cost to the client — ever.

No. A licensed agent like Johnny can enroll you directly in the same ACA Marketplace plans through carrier-approved enrollment portals — same plans, same subsidies, same prices. The difference: an agent verifies your doctors and hospitals are in-network first.

HealthSherpa is a technology platform — it's the same portal many independent agents (including Johnny) use to enroll clients. The difference is the human on the other end. With a local agent, you get someone who checks your specific doctors and hospitals, knows the Palm Beach County networks, answers your texts a year from now when you have a claim question, and doesn't work off a call-center script.

About 15–20 minutes on a single phone call or via secure e-signature. Most clients call, review plans, verify their doctors are in-network, and enroll — all in one sitting. Coverage typically starts the first of the following month if enrolled by the 15th.

You'll need Social Security numbers for everyone on the application, projected household income for the coverage year, current health coverage details (if any), immigration document numbers (if applicable), and employer coverage information (if applicable). That's it.

For 2027 coverage, Open Enrollment runs November 1, 2026 through December 15, 2026 for coverage starting January 1, 2027. This is a shortened window compared to prior years — miss it and you generally cannot enroll until the following year unless you have a Special Enrollment Period.

An SEP is a 60-day window to enroll in health insurance outside of Open Enrollment, triggered by a qualifying life event: losing job-based coverage, getting married or divorced, having a baby, moving to a new ZIP code, aging off a parent's plan at 26, becoming a U.S. citizen, or losing Medicaid coverage.

ACA subsidies (called Advance Premium Tax Credits) reduce your monthly premium based on your projected household income for the coverage year. Most Palm Beach County families earning between 100% and 400% of the Federal Poverty Level qualify. Some families qualify for zero-premium Silver plans. Your subsidy is calculated on your income estimate — if your income changes mid-year, you may owe or be refunded at tax time.

You use your projected Modified Adjusted Gross Income (MAGI) for the coverage year — not last year's income. That is your wages, self-employment income, taxable interest, dividends, capital gains, IRA distributions, and Social Security. Being conservative with your estimate is safer than under-estimating.

Bronze plans have the lowest monthly premium but highest deductibles — good for healthy people who rarely use care. Silver plans balance premium and deductible, and are the only tier where cost-sharing reductions apply if your income qualifies. Gold plans have higher premiums but much lower deductibles and copays — good for families or people with ongoing prescriptions or specialists. Platinum is rarely worth it in Florida. For most middle-income Palm Beach County families, Silver with cost-sharing reduction is the best value.

An HMO (Health Maintenance Organization) requires you to use in-network providers only and typically requires a primary care physician (PCP) referral to see a specialist. Premiums are lower. A PPO (Preferred Provider Organization) lets you see any doctor without a referral, and offers partial coverage for out-of-network care. Premiums are higher. Most Florida ACA plans in 2026 are HMOs — PPO options are limited and pricier.

No — lawfully-present immigrants qualify for ACA Marketplace plans and, in most cases, ACA subsidies. Green card holders, refugees, asylees, DACA recipients (in most states), and many visa holders are eligible. Undocumented immigrants are not eligible for ACA plans or subsidies but can purchase off-exchange coverage in Florida.

The deductible is what you pay before insurance starts paying. The out-of-pocket maximum is the absolute most you can spend in a year on covered in-network care (deductible + copays + coinsurance). Once you hit the out-of-pocket maximum, the plan pays 100% for the rest of the calendar year. For 2026 ACA plans, the maximum out-of-pocket by law is $9,200 individual / $18,400 family — but many plans are lower.

Short-term medical plans are cheaper but do not cover pre-existing conditions, mental health, maternity, or prescription drugs to the same extent as ACA plans. They are a bridge — good for a gap of 1–3 months between jobs or before Medicare — but not a long-term substitute for real coverage. Most Palm Beach County clients qualify for an ACA subsidy that makes them cheaper than short-term anyway.

During Open Enrollment (Nov 1–Dec 15), yes — anyone can switch plans. Outside of Open Enrollment, you need a Special Enrollment Period. A common one many people don't know about: if you're on an ACA plan and your income projection changes significantly, you may qualify for an SEP to switch.

Johnny doesn't file taxes but can help you retrieve your Form 1095-A from the Marketplace and explain how it affects your tax return. Any subsidies you received are reconciled on Form 8962 with your tax filing — your tax preparer handles the actual filing.

Yes — and self-employed people often qualify for larger ACA subsidies than employees because their income is lower after deducting business expenses. Many self-employed clients in Palm Beach County get comprehensive coverage for under $150/month after subsidies. The key is projecting your net self-employment income correctly.

1099 contractors have the same options as anyone without employer coverage: ACA Marketplace plans (with subsidies based on your net income), off-exchange private plans (no subsidies but broader network options), short-term medical plans (limited-duration, not ACA-compliant), or spousal coverage through a partner's employer. An ACA subsidized plan is usually the best value for full-year coverage.

An ICHRA (Individual Coverage HRA) lets a small business reimburse employees tax-free for their own individual health insurance premiums instead of offering a group plan. It is often cheaper and simpler than a traditional small-group plan for businesses under 20 employees. Setup takes about 30 days.

Yes. Losing job-based coverage triggers a 60-day Special Enrollment Period. You can enroll in an ACA Marketplace plan (often with substantial subsidies now that you have no income) with coverage effective the first of the following month. This is almost always cheaper than COBRA.

Almost never. COBRA charges you the full unsubsidized premium plus a 2% administrative fee — often $700–$2,500/month for a family. An ACA plan after job loss usually costs a fraction of that because your subsidy is calculated on your reduced income.

Yes, and this is one of the sweet spots for ACA subsidies. If your projected income after retirement (from investments, Roth conversions, part-time work) falls between 100% and 400% of the Federal Poverty Level, you qualify for premium subsidies. Many early retirees with $50–$70k of projected income get comprehensive coverage for under $250/month.

Only during the next Open Enrollment Period (Nov 1–Dec 15 for the following calendar year) unless you have a qualifying life event that triggers an SEP. This is why verifying doctors and prescriptions before enrolling is critical.

Your Initial Enrollment Period is 7 months long — starting 3 months before your 65th birthday month, including your birthday month, and 3 months after. Enroll in Medicare Part A and Part B first (usually free/subsidized). Then choose between Original Medicare + Medigap + Part D, or a Medicare Advantage plan that bundles everything. A local agent can walk you through the choice — it depends on your doctors, prescriptions, and travel patterns.

Medicare Advantage (Part C) bundles hospital, medical, and usually prescription coverage in one plan — often with $0 premium but with network restrictions and prior-authorization requirements. Medicare Supplement (Medigap) pairs with Original Medicare to pay the gaps — higher monthly premium but no network restrictions and predictable out-of-pocket costs. If you travel, see many specialists, or have complex health needs, Medigap is usually better. If you're healthy and want $0 premium, Medicare Advantage can be great.

Part D is standalone prescription drug coverage for people on Original Medicare. Every Part D plan has a different formulary (list of covered drugs) and different pharmacy networks. An agent runs your specific prescriptions through each available plan and shows you which one costs the least for your drugs — including all copays, deductibles, and the coverage gap. This one step often saves clients hundreds per year.

IRMAA (Income-Related Monthly Adjustment Amount) is a Medicare surcharge on Part B and Part D premiums for higher-income enrollees. For 2026, it kicks in above about $103,000 individual / $206,000 joint MAGI (based on your tax return from two years prior). If a life event like retirement dropped your income, you can appeal IRMAA using SSA Form SSA-44.

Major Palm Beach County hospitals include Bethesda Hospital East and West (Boynton Beach), JFK Medical Center (Atlantis/Lake Worth), Good Samaritan and St. Mary's (West Palm Beach), Wellington Regional (Wellington), Palms West (Loxahatchee), Jupiter Medical Center (Jupiter), Palm Beach Gardens Medical Center (Palm Beach Gardens), Delray Medical Center (Delray Beach), and Boca Raton Regional Hospital (Boca Raton). Every plan has a different network — always verify before enrolling.

Never trust the plan's website search alone — it is often out of date. Best practice: call your doctor's billing office directly and ask which specific plans they accept for the upcoming plan year. A local independent agent will do this verification for you before you enroll, at no cost.

Only if your doctor is in-network on the new plan. Networks change every year — a doctor who was in-network in 2026 may not be in 2027 with the same carrier. Always verify with the doctor's office before switching plans.

Yes — almost all ACA and Medicare plans exclude adult dental (children's dental is included in ACA). Standalone dental plans typically cost $15–$45/month for individual coverage with $1,000–$2,000 annual maximums. Vision plans run $8–$20/month. Both can be added anytime — no enrollment window.

Call or text Johnny at (561) 560-8820. Insurance Near Me is a local, family-run agency based in Greenacres, FL 33463, serving all of Palm Beach County. Free help — carriers pay the agent's commission.

Yes — Wellington, Loxahatchee, The Acreage, Royal Palm Beach, and Loxahatchee Groves are all part of the primary service area. Johnny knows the Wellington Regional and Palms West Hospital networks and which plans include each.

Yes — Jupiter, Palm Beach Gardens, Tequesta, and Juno Beach are core service areas. Johnny is familiar with Jupiter Medical Center, Palm Beach Gardens Medical Center, and the new Alan B. Miller Medical Center in Palm Beach Gardens (opened 2025).

Yes. Johnny is licensed in Florida and most U.S. states. He regularly enrolls clients in Miami-Dade, Broward, St. Lucie, and Martin counties, plus out-of-state clients in Texas, Pennsylvania, and beyond. Local knowledge of Palm Beach County hospital networks is deepest, but he can help almost anywhere in the country.