Question 1

What does it cost to work with an advisor?

Accepted Answer

Nothing. Advisors are compensated by the insurance carriers, and premiums are filed with the state — the plan costs the same whether you enroll through us or on your own.

Question 2

Can I get covered outside of open enrollment?

Accepted Answer

Often, yes. A qualifying life event — losing job-based coverage, moving, marriage, divorce, a birth or adoption, or aging off a parent's plan — opens a special enrollment period. Short-term and supplemental products can also be written year-round in many states.

Question 3

I am self-employed. What are my options?

Accepted Answer

Marketplace coverage with a properly estimated income, off-exchange private plans, or a combination of a lower-premium medical plan paired with hospital indemnity or accident coverage. Which one wins depends on your income variability and expected care.

Question 4

How much does individual health insurance cost?

Accepted Answer

It depends on age, ZIP code, tobacco use, plan tier, and whether you qualify for a premium tax credit. Two people the same age in different states can differ by hundreds of dollars a month, which is exactly why a quote beats an average.

Question 5

Can I get family health insurance if I have a pre-existing condition?

Accepted Answer

Yes. ACA-compliant plans, on or off the Marketplace, cannot deny coverage or charge more for pre-existing conditions. Short-term medical plans can and do exclude them, which is why we only use short-term for defined gaps.

Question 6

Is it cheaper to add my spouse to my employer plan or buy an individual plan?

Accepted Answer

Frequently the individual plan wins, because many employers subsidize the employee heavily and the dependents barely at all. We price both before you decide.

Question 7

When can I enroll?

Accepted Answer

During the annual open enrollment window, or any time you have a qualifying life event such as losing coverage, moving, marrying, divorcing, or having a baby. Details are on the open enrollment page.

Question 8

Do you charge a fee?

Accepted Answer

No. Compensation comes from the carrier and premiums are state-filed, so working with an advisor does not raise your rate.

Question 9

What is the best health insurance for self-employed people?

Accepted Answer

There is no single answer — it turns on income level, prescriptions, travel, and risk tolerance. Roughly, subsidy-eligible incomes usually do best on the Marketplace, and higher incomes with broad-network needs usually do best off-exchange.

Question 10

Can I deduct my health insurance premiums?

Accepted Answer

Many self-employed taxpayers can deduct premiums for themselves, a spouse, and dependents, subject to IRS rules and net profit. Confirm with your tax professional — the deduction can change which plan is truly cheapest.

Question 11

I am a 1099 contractor. Do I qualify for Marketplace subsidies?

Accepted Answer

Possibly. Eligibility depends on estimated household income and whether affordable employer coverage is available to you or a spouse. We run the estimate as part of the quote.

Question 12

What happens if I earn more than I estimated?

Accepted Answer

Advance premium tax credits reconcile on your tax return, so you may repay some of the credit. Reporting income changes during the year keeps the surprise small.

Question 13

Can I get coverage that works in multiple states?

Accepted Answer

Yes — that is typically a national PPO network. It is one of the main reasons self-employed clients choose an off-exchange plan.

Question 14

How many employees do I need for a group health plan?

Accepted Answer

In most states, two enrolled employees can establish a small group, though carriers set participation and contribution minimums. We confirm the specific rules for your state and carrier before quoting.

Question 15

How much does the employer have to contribute?

Accepted Answer

Carriers typically require the employer to fund a minimum share of the employee-only premium. Beyond that minimum, the contribution strategy is yours, and it drives both participation and total cost.

Question 16

Can I offer benefits to some employees and not others?

Accepted Answer

Eligibility must follow consistent, non-discriminatory classes — for example, full-time employees working a set number of hours. You cannot pick individuals.

Question 17

What if my renewal increase is unreasonable?

Accepted Answer

That is exactly when to shop. We market the group to other carriers and compare the alternative plan designs against what the incumbent proposed.

Question 18

Do you help with dental and vision too?

Accepted Answer

Yes, both group and voluntary employee-paid options, which often add meaningful perceived value at low employer cost.

Question 19

Does using an agent cost more than enrolling myself?

Accepted Answer

No. Marketplace premiums are set by the carrier and filed with the state. Your rate is identical either way; the advisor is compensated by the carrier.

Question 20

What income do I report for a subsidy?

Accepted Answer

Estimated modified adjusted gross income for the coverage year for everyone on the tax return — not last year's number if this year will differ.

Question 21

Can I be denied for a pre-existing condition?

Accepted Answer

No. ACA-compliant plans are guaranteed issue and cannot rate you or exclude care based on health history.

Question 22

Why should I look at silver instead of bronze?

Accepted Answer

At qualifying incomes, silver plans include cost-sharing reductions that cut the deductible and copays substantially. Bronze may look cheaper monthly while costing far more the first time you use it.

Question 23

Can I switch plans mid-year?

Accepted Answer

Only with a qualifying life event, such as losing coverage, moving, marriage, divorce, or a birth. Otherwise changes wait for open enrollment.

Question 24

Is private health insurance better than a Marketplace plan?

Accepted Answer

Better only in specific circumstances — mainly income above the subsidy range, or a need for a broad national network. Below the subsidy threshold, the Marketplace usually wins on price by a wide margin.

Question 25

Can I keep my current doctor on a PPO plan?

Accepted Answer

Usually, and we verify it before recommending the plan. PPOs also cover out-of-network care at a higher cost share, which is a safety valve narrower networks do not have.

Question 26

Do private plans cover pre-existing conditions?

Accepted Answer

ACA-compliant private plans do. Short-term and limited-benefit products generally do not, which is why the product category has to be identified clearly.

Question 27

Are PPO plans available in every state?

Accepted Answer

Availability varies by state and county. We are licensed in 31 states and check what is genuinely available at your address.

Question 28

Can I get a private plan any time of year?

Accepted Answer

Many off-exchange products can be written outside open enrollment, though effective dates and underwriting rules vary. That is one of their practical advantages.

Question 29

When is open enrollment?

Accepted Answer

Dates are set annually and some state-run exchanges extend them. We confirm the current window for your state when you contact us.

Question 30

How long does a special enrollment period last?

Accepted Answer

Typically 60 days from the qualifying event, though some events allow a window before and after.

Question 31

Does quitting my job count as losing coverage?

Accepted Answer

Losing job-based coverage generally qualifies, including after resignation. Voluntarily dropping an individual plan does not.

Question 32

What if I miss the deadline entirely?

Accepted Answer

Year-round options include short-term medical for healthy applicants, supplemental products, and Medicaid or CHIP if you are income-eligible.

Question 33

Can I change plans mid-year if I am unhappy?

Accepted Answer

Not without a qualifying event. This is why the initial comparison matters so much.

Question 34

How long can a short-term plan last?

Accepted Answer

It depends entirely on state law and the specific product; some states allow several months, others sharply restrict duration or prohibit the product. We confirm your state's current rules when quoting.

Question 35

Does short-term insurance cover pre-existing conditions?

Accepted Answer

Generally no. Applications include health questions, and conditions you already have are typically excluded from coverage.

Question 36

Is short-term insurance the same as a Marketplace plan?

Accepted Answer

No. It is not ACA-compliant, does not include all essential health benefits, and does not receive premium tax credits.

Question 37

Can I get short-term coverage quickly?

Accepted Answer

Usually yes — often effective as soon as the next day, which is why it works well for an unexpected gap.

Question 38

What is the better option if I am not healthy?

Accepted Answer

An ACA-compliant plan, either on the Marketplace or off-exchange. Losing prior coverage is a qualifying event, so the exchange is frequently open to you.

Question 39

Do all health plans cover prescriptions?

Accepted Answer

All ACA-compliant plans include prescription coverage as an essential health benefit. Short-term and limited-benefit products often do not.

Question 40

What if my drug is not on the formulary?

Accepted Answer

You can request an exception, switch to a covered alternative, or select a plan whose formulary includes it. We check this before enrollment rather than after.

Question 41

Will my copay be the same all year?

Accepted Answer

Not necessarily. Copays can apply before the deductible for some tiers and coinsurance after it for others, and formularies can change annually.

Question 42

Are discount cards better than insurance?

Accepted Answer

Sometimes on inexpensive generics. But those payments usually do not count toward your deductible or out-of-pocket maximum.

Question 43

How do I lower specialty drug costs?

Accepted Answer

Plan selection matters most, followed by manufacturer assistance programs and correct pharmacy channel use. We start with the plan comparison.

Question 44

Does health insurance include dental?

Accepted Answer

Children's dental is an essential health benefit under the ACA, but adult dental generally is not included in major medical. Most adults need a standalone plan.

Question 45

Is there a waiting period for major dental work?

Accepted Answer

Usually. Many plans impose a waiting period before covering crowns, bridges, and dentures, though some waive it if you had continuous prior coverage.

Question 46

Can I keep my dentist?

Accepted Answer

If they participate in the plan's network. We verify that before recommending a plan, since out-of-network care costs substantially more.

Question 47

Can I buy dental insurance any time of year?

Accepted Answer

Standalone dental is generally available year-round, unlike major medical, which is limited to open enrollment or a qualifying event.

Question 48

Do you offer dental for small businesses?

Accepted Answer

Yes, both employer-paid group dental and voluntary employee-paid options.

Question 49

When should I start looking at Medicare?

Accepted Answer

Three to six months before your 65th birthday, since the initial enrollment period opens three months before your birthday month.

Question 50

What if I am still working at 65?

Accepted Answer

You may be able to delay Part B without penalty depending on your employer's size and plan. Confirm your specific situation before declining anything.

Question 51

Is Medicare Advantage cheaper?

Accepted Answer

Often lower in premium, but you pay cost sharing as you use services and must stay in network. Total annual cost depends on how much care you use.

Question 52

What do I do between early retirement and 65?

Accepted Answer

Individual coverage, usually ACA-compliant, with careful attention to how retirement income affects subsidy eligibility.

Question 53

Are you affiliated with the government?

Accepted Answer

No. Swierc Health is an independent insurance agency and is not connected with or endorsed by any government agency.

Health insurance FAQ

Working with an advisor

Individuals & families

Self-employed & 1099

Small business & groups

ACA Marketplace & subsidies

Private & PPO plans

Enrollment windows

Coverage gaps & short-term

Prescriptions

Dental & vision

Medicare

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