Insurance Questions? We Have Straight Answers.

Every ACA-compliant policy must cover ten Essential Health Benefits — preventive care, emergency services, hospitalization, prescriptions, mental health, maternity, pediatric services, lab work, rehabilitative care, and outpatient services. What changes plan to plan is the depth of each layer: copay amounts, deductibles, coinsurance percentages, network breadth, and formulary tiers. The Meet Policies breakdown charts each of those for the specific plan you're considering, so 'covered' becomes a number, not a feeling.

Start with the Summary of Benefits & Coverage (SBC) — every carrier must produce one. Inside, locate four numbers in order: the monthly premium, the annual deductible, the out-of-pocket maximum, and the coinsurance percentage. Then check the network directory for your providers and the formulary for your prescriptions. Meet Policies pulls all of this together in a single spec sheet so you don't have to chase a dozen PDFs.

Deductible: what you pay before the carrier starts cost-sharing. Out-of-pocket max: the absolute ceiling on what you'll spend in a calendar year on covered, in-network care — including deductible, copays, and coinsurance. Once you hit the OOP max, the carrier pays 100% of covered in-network costs for the rest of the year. The gap between the two is the coinsurance band.

A copay is a fixed dollar amount per service ($30 PCP visit, $50 specialist, $15 generic Rx). Coinsurance is a percentage of the negotiated cost after the deductible (commonly 20% of a $1,000 procedure = $200). Many plans use both, layered against the same OOP max.

Only if those doctors are in-network on the new policy. Meet Policies cross-checks your physicians, hospitals, and specialists against each carrier's current network directory before we recommend anything. Provider directories change quarterly, so we re-verify on every breakdown.

A formulary is the carrier's list of covered drugs, organized into tiers (typically 4–6). Tier 1 is usually generics with the lowest copay; Tier 4–5 covers specialty drugs with the highest cost share, often coinsurance instead of a flat copay. Two plans with identical premiums can have radically different formulary placement for the same drug. We chart this by drug name, not by tier label.

An HSA pairs with a qualified High Deductible Health Plan (HDHP). You contribute pre-tax dollars (2025 limits: $4,150 individual, $8,300 family) and spend them tax-free on qualified medical expenses. HSA funds roll over indefinitely and become a long-term tax-advantaged account — often the most efficient retirement-health savings vehicle in the U.S. tax code.

ACA Open Enrollment runs November 1 to January 15 for the following plan year. Outside that window, you need a Qualifying Life Event (job loss, marriage, birth, move, aging off a parent's plan, citizenship change) which opens a 60-day Special Enrollment Period. Off-exchange short-term plans are typically available year-round, with very different rules.

If your household income falls between 100% and 400% of the Federal Poverty Level you qualify for premium tax credits, and under current legislation eligibility extends above 400% FPL for many households. For 2025 a family of four earning up to $124,800 may still qualify for meaningful assistance. Our breakdown computes your subsidy automatically when you share your ZIP and household details.

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