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The Detective's notebook

Plain-English health insurance guides

Written and reviewed by Dick Tracy, licensed health insurance broker (NPN 20414610) · New guide most Mondays · Updated September 14, 2026

Richard 'Dick' Tracy, Your Insurance Detective, independent health insurance broker in Buffalo NY, USA Benefits Group, 716-503-1113

Everything I write lives here. These are the questions people actually ask me on the phone, answered the way I answer them: what the option is, who it fits, where the trap is, and what I would do in your shoes. Read whatever applies to you. I educate, you decide.

All guides

Is this a health share ministry or real insurance? How to tell what you are actually buying

The question I now get on almost every call, answered straight: no, a health care sharing ministry is not insurance, has no carrier behind it, and is not legally required to pay your bill. Colorado made them report their books and members submitted about $362 million in bills while the ministries deemed only about a third of it, roughly $132 million, eligible to share. The four questions that sort it out in ten minutes, and what a real ERISA group plan gives you instead.

Supplemental insurance for gig workers and 1099s: what to layer, in what order, and what to skip

No employer, no workers' comp, no benefits menu, so you are the benefits department now. The order I build the stack in: real medical coverage first, then accident cover from $31.95 a month that pays PRIMARY in New York, then hospital cash where it is offered, then dental. Plus the skip list that costs me money to write: vision plans, short-term medical, and health shares.

How much does a broken bone cost, and does accident insurance cover it?

The average emergency room visit runs $2,453 all in with $646 out of your pocket (Peterson-KFF), and a break that needs surgery is a different animal: one carrier's worked example for a fractured leg with two hospital nights came to about $29,700 billed. What is actually on the bill, what you owe with and without coverage, how to check it before you pay, and the cash layer that pays you instead of the hospital.

Essential Plan vs a marketplace plan in New York: which one are you supposed to be on?

One number decides it: 200% of the federal poverty level, $31,920 for one person and $66,000 for a family of four in 2026. Under it, the Essential Plan at $0 premium and no deductible, and I say so out loud even though I do not sell it. Over it, what a marketplace plan really costs you, and the ERISA group door most New Yorkers never get shown.

How much does health insurance cost per month for a couple or a family?

The broker's ballpark, out loud: your age plus a zero per person, so $650 to $700 a month for a young couple and around $1,100 for a family on a $1,500 deductible plan. Then the four details that turn a ballpark into a real price, the 2026 KFF averages nobody puts next to each other, and every door that brings the number down.

Health insurance broker serving Amherst and Williamsville, NY

There is a broker in Amherst: my Main Street address in Snyder sits inside the town. Written for the Northtowns: UB grad students, postdocs, and adjuncts after the school plan ended in 2024, self-employed physicians and therapists on the Maple Road medical corridor who earn over the 2026 subsidy line, and owners who were only ever shown the marketplace. Three doors, 2026 Erie County prices, no fee to you.

How to choose a health insurance broker in New York: 9 things to check before you pick one

Nobody gets to call themselves the best broker in New York. Here are the two free license lookups, the NPN, the New York rules a broker has to know, the questions to ask on the first call, and the red flags.

Best health insurance options for self-employed people in Buffalo, NY: five doors, 2026 prices, and the group plan nobody prices

Opens with the monthly number: $0 on the Essential Plan up to about $610 Bronze, $817 Silver, $1,057 Gold at full price. Then the five doors ranked by income and health, the 2026 Erie County carriers, why the company you 1099 for won't cover you, the no-repayment-cap subsidy trap, the tax deduction, client quotes, and the 60-second $1,200-to-$379 video.

ACA Subsidy Calculator 2026: how much premium tax credit will you actually get?

Not a yes-or-no. A dollar estimate. Pick your state, household size, income, and ages and see your monthly credit, the most you pay for the benchmark silver plan under the 2026 IRS table, and your cushion under the 400% cliff. Handles New York community rating, California's state subsidy, and all 25 states I serve. Plus the full 2026 income limits table by family size.

Covered California income limits 2026: Medi-Cal, the state subsidy, and the penalty, by family size

Every 2026 line for households of one to eight: the Medi-Cal cutoff, California's own subsidy to 165% of poverty, the Silver 94/87/73 bands, and the 400% federal ceiling. Plus the state penalty for going uninsured, the 10.3% rate change, and why the private-plan door is closed here while the ERISA door is open.

NY State of Health income limits 2026: Medicaid, Essential Plan, Child Health Plus, and tax credits by family size

Four programs on one ladder, every rung for households of one to eight, the Essential Plan's new 200% ceiling, why age does not change the price in New York, and the Buffalo-versus-NYC silver prices (.62 vs .61). Plus the one number on the state chart the IRS reads differently.

Pennie income limits 2026: Pennsylvania's Medicaid, CHIP, and tax credit lines by family size

Tax credits from ,650 to ,600 for one person, Medical Assistance to ,025, CHIP free to 208% of poverty and low-cost to 314%. Why Pennsylvania pays no state subsidy, the 21.5% approved increase, the 160,000 people who left Pennie, and the underwritten-plan door that New Yorkers do not have.

Maryland Health Connection income limits 2026: Medicaid, MCHP, two state subsidies, and tax credits by family size

The softest landing in the country for a family near the line: Maryland Premium Assistance replaces the lost enhanced credit for most enrollees, a second subsidy covers ages 18 to 37, and the benchmark silver is a month, the lowest of my 25 states. Every line by family size, the 13.4% approved increase, and the tax-return checkbox that enrolls you late.

When is open enrollment for 2027 health insurance? Dates by state, and why to raise your hand now

November 1, 2026 to January 15, 2027 in most states, January 31 in New York, and December 15 is the day that matters for a January 1 start. The rule that would have cut it to December 15 got thrown out in June. Every date for the 25 states I serve, the 15 percent median 2027 rate request, and a 20-second early list so I call you first.

What are the alternatives to COBRA in Pennsylvania? Mini-COBRA, the 60-day window, and your five options

Pennsylvania has two COBRA clocks: 60 days under federal COBRA, only 30 under the state's mini-COBRA for small employers. And because Pennsylvania allows private underwriting, all five buckets of coverage exist here. Which door for which household, the layoff moves most people miss, and when COBRA still wins.

How do you save money on prescriptions? 9 ways, ranked from biggest savings to smallest

The coupon everybody knows about is the worst rung on the ladder. The drug maker's free-drug program, a manufacturer copay card, and a generic cousin from your doctor can take a $1,594 brand name to $0, $5, or $15 a month. All nine rungs ranked, with a table of which ones work on a marketplace plan, on Medicare, and with no insurance at all.

Private health insurance vs the marketplace in 2026: which is actually cheaper?

One question decides it, and it is not which plan is better: do you get a subsidy? The real KFF 2026 sticker prices, the 400% cliff numbers, where an underwritten plan genuinely beats the marketplace, where it cannot, and the third door most comparisons leave out entirely.

What are the 5 types of health insurance for people under 65? The five buckets explained

Marketplace, group (including the pre-established group plans an individual can merge into), short-term, healthcare sharing, and defined benefit. Which ones are guaranteed issue, which are guaranteed renewable, which exist in your state, and the holes in every one. With a chart you can save and share.

What are the alternatives to COBRA insurance? Your options after a layoff, in any state

COBRA is 102% of the full premium and you have 60 days to decide. The other four buckets you can choose from inside that window, which ones exist in your state, the layoff moves most people miss, and when COBRA is still the right call.

How much is health insurance per month in New York if you're self-employed? The real 2026 numbers

From $0 a month on the Essential Plan to $817 for the benchmark Silver at full price, with the actual published 2026 figures for every band in between. Why your age never changes the number in New York, what the subsidy cliff does to your price, real Erie County rates, and the one door that is not community rated at all.

Delta Dental plans in New York: compare your options and enroll online

Your marketplace plan was never going to fix your teeth: adult dental is not an essential health benefit and your subsidy does not touch a stand-alone dental premium. Here is the honest side-by-side of Delta's PPO Basic, PPO Premium, and DeltaCare USA for New Yorkers, and the 10-minute online enrollment. Same price as going direct, with a broker in your corner.

Dental insurance with no waiting period: what it really pays (implants covered, ages 18 to 99)

"No waiting period" is technically true and half the story. Cleanings covered 100% from day one, but major work pays 10% in year one and 60% after, and I print that number in bold because you deserve the math up front. Implants covered, rates lock at your issue age, and it issues to age 99. Available in 14 states, online in minutes.

Accident insurance for self-employed people and families: the safety net nobody told you about

No workers' comp when you work for yourself. This 24-hour accident plan (underwritten by a Chubb company) pays accident medical bills up to $10,000 with automatic acceptance through age 64, from $31.95 a month. And for New Yorkers it pays PRIMARY, before your health plan's deductible even wakes up.

Guaranteed-issue hospital cash: real options when you have been told no

No health questions, no underwriting: $5,000 or $10,000 cash on a hospital admission plus $250 a day, paid to you on top of any other coverage, from $40 a month. And the sentence half the internet forgets: this is a limited benefit plan, NOT health insurance. The honest version of a product that gets sold dishonestly all the time.

COBRA vs a marketplace plan in 2026: which one should you take?

COBRA runs about $793 a month single and $2,294 family; the 2026 marketplace averages $456 bronze and $625 benchmark silver before any subsidy. Which one wins comes down to four things, not just the premium, and the 60-day election window is a shopping tool most people waste. Plus the third door nobody prices for you.

How to save money on healthcare (even when you have insurance): the free Resource Kit

Healthcare has two price tags, and you are allowed to look at both. Ask for the cash price before you hand over your card, never pay the first price on a prescription, and match every bill to your EOB before you pay a dime. Plus the free Resource Kit: the exact tools I use, saved right to your phone, no login and no email required.

The NY Essential Plan changed July 1, 2026: who still qualifies and what to do now

The Essential Plan still exists with $0 premiums and no deductible for incomes up to $31,920 single or $66,000 for a family of four. But the upper tier ended July 1 under a federal budget law, 450,000 New Yorkers lost it, and the no-gap enrollment window closed August 30. Who is protected, what a marketplace plan costs now, and the moves left if you missed the deadline.

Child Health Plus in New York: who qualifies, what it costs, and how to enroll

New York covers kids under 19 for $0 to $60 a month per child, capped at three kids, with no deductible and no copays, and you can enroll any time of year. The full 2026 income table by family size, what it covers (dental and medically necessary orthodontia included), and when kids on Child Health Plus plus parents on their own plan beats one big family plan.

Health insurance in Niagara Falls, NY for self-employed people

Three doors in a community-rated state, plus the trap specific to the Falls: your plan list is set at the Niagara County line while most of your serious care is in Buffalo. What seasonal tourism income does to a 2026 subsidy estimate, and why the Essential Plan is the door hospitality workers were never shown.

What is an EOB? How to read it, and why it is not a bill

Billed amount, allowed amount, plan paid, what you owe: the four numbers on every Explanation of Benefits, what the write-off line really means, and the four-minute check that stops you paying a bill you do not owe. Plus what to do when the EOB says denied, and when there is no EOB at all.

Health insurance in Syracuse, NY for self-employed people

Three doors in a community-rated state, plus the Syracuse question that decides everything: are your doctors at Upstate, St. Joseph's, or Crouse, and does the plan actually reach them? Why Onondaga County is its own plan market, and what the university-and-hospital economy means if you work 1099.

Health insurance in Albany, NY for self-employed people

You live in a four-county metro but you buy insurance in exactly one county, and Albany, Rensselaer, Saratoga, and Schenectady are four different plan lists. Three doors for state contractors and Tech Valley consultants, plus why project-cycle income makes 2026 subsidy estimates risky.

Health insurance in Charleston, WV for self-employed people

West Virginia has one of the shortest marketplace carrier lists in the country, and most people here look at one expensive quote and give up. That is one door of four. What the other three are for energy contractors, trades, and family businesses in Kanawha County.

Health insurance in Portland, Maine for self-employed people

Seasonal income plus a short carrier list is a rough combination, and 2026 removed the cap on paying back an overpaid subsidy. Four doors for Portland owners, including the fixed indemnity layer that sits on top of your plan and knocks down the deductible.

Health insurance in Wilmington, DE for self-employed people

Your life crosses into Pennsylvania and Maryland and your plan might not. Why the border question should decide your coverage before the premium does, and four doors for the consultant economy that Delaware's incorporation industry created.

Health insurance in Lexington, KY for self-employed people

Horse country runs on 1099 income that arrives around sales and racing calendars, and the insurance system was not built for it. Four doors for trainers, farriers, bloodstock agents, trades, and university freelancers, plus what kynect does and does not do.

Health insurance in Madison, WI for self-employed people

Madison is a system town, which makes the network question sharper here than almost anywhere. Four doors for contract researchers, biotech consultants, and state contractors, plus why grant-cycle income and the 2026 repayment rules do not mix.

Health insurance in Tucson, AZ for self-employed people

Two Tucson situations that premium shopping handles badly: bridging from an early retirement to Medicare at 65, and splitting the year between here and somewhere else. Four doors, and why a Pima County network may do very little for you in February.

Health insurance in Rochester, NY for self-employed people

Three doors in a community-rated state, plus the Rochester question that decides everything: are your doctors at Rochester Regional or UR Medicine, and does the plan actually reach them? Why Monroe County is its own plan market, and what the Kodak-to-freelance shift did to coverage here.

Health insurance in Tampa, FL for self-employed people

Four doors in an underwriting state, plus the Tampa Bay trap: Hillsborough, Pinellas, and Pasco are three different plan markets, and the drive across the bay is a network boundary. How to check BayCare, Tampa General, AdventHealth, and Moffitt before you enroll.

Health insurance in Houston, TX for self-employed people

Four doors in an underwriting state, plus the Houston paradox: you live next to the largest medical complex in the world and a narrow plan can still leave you outside it. Harris, Fort Bend, and Montgomery are three plan markets, and COBRA is rarely the best door between contracts.

Health insurance in Phoenix, AZ for self-employed people

Four doors in an underwriting state, plus what affordable really costs in Maricopa County, where most marketplace plans are narrow-network designs. How to check Banner, HonorHealth, Dignity, and Mayo Clinic Arizona, and why snowbirds need a network that travels.

Health insurance in Nashville, TN for self-employed people

Four doors in an underwriting state, built for a city that runs on 1099 income. Why the 2026 no-repayment-cap rule hits musicians and crew hardest, how to check Vanderbilt, Ascension Saint Thomas, and TriStar, and why a Davidson County plan may not travel with the van.

Health insurance in New York for self-employed people: what are your options?

Three doors, not four: a pre-established ERISA group plan you join as a solo owner, NY State of Health (or the same plans off-exchange) with its 2026 subsidy cliff, and supplemental layers. Why community rating makes New York the toughest state for a healthy self-employed person, how carriers and networks differ from Buffalo to NYC, and how much you can deduct.

Health insurance in Connecticut for self-employed people: what are your options?

Three doors, not four: a pre-established ERISA group plan you join as a solo owner, Access Health CT (or the same plans off-exchange) with its 2026 subsidy cliff, and supplemental layers. Why Connecticut has no plans priced on your health, which private providers in CT you can use, what drives cost, and how much self-employed health insurance you can deduct.

Kentucky health insurance for self-employed people: what are your options?

Four doors, not one: a private PPO plan priced on your health, a fixed-benefit plan, the kynect marketplace with its 2026 subsidy cliff, and a pre-established ERISA group plan. Which private health insurance providers in Kentucky you can use, what drives cost from Louisville to Lexington, and which door fits you.

Health insurance in Wisconsin for self-employed people: what are your options?

Four doors, not one: a private PPO plan priced on your health, a fixed-benefit plan, the healthcare.gov marketplace with its 2026 subsidy cliff, and a pre-established ERISA group plan. Which private health insurance providers in Wisconsin you can use, what drives cost per month from Milwaukee to Madison to Green Bay, and which door fits you.

Health insurance in West Virginia for self-employed people: what are your options?

Four doors, not one: a private PPO plan priced on your health, a fixed-benefit plan, the healthcare.gov marketplace with its 2026 subsidy cliff, and a pre-established ERISA group plan. How to get health insurance in WV without an employer, which individual plans you can use, private insurance vs self-pay, and what drives cost from Charleston to Morgantown.

Health insurance in Maine for self-employed people: what are your options?

Three doors, not four: a pre-established ERISA group plan you join as a solo owner, CoverME.gov (or the same plans off-exchange) with its 2026 subsidy cliff, and supplemental layers. Which private health insurance providers in Maine you can use, what drives cost from Portland to Bangor, seasonal-income traps, and the self-employed deduction.

Health insurance in Delaware for self-employed people: what are your options?

Four doors, not one: a private PPO plan priced on your health, a fixed-benefit plan, the healthcare.gov marketplace with its 2026 subsidy cliff, and a pre-established ERISA group plan. Which individual health insurance plans in Delaware you can use, what drives cost from Wilmington to the beaches, and which door fits you.

Health insurance in Massachusetts for self-employed people: what are your options?

Three doors, not four: a pre-established ERISA group plan you join as a solo owner, the Massachusetts Health Connector (or the same plans off-exchange) with its 2026 subsidy cliff, and supplemental layers. Why Massachusetts has no plans priced on your health, the state coverage requirement, and the Massachusetts self-employed health insurance deduction.

Health insurance in Maryland for the self-employed: what is the best option?

Three doors, not four: a pre-established ERISA group plan you join as a solo owner, Maryland Health Connection (or the same plans off-exchange) with its 2026 subsidy cliff, and supplemental layers. Why Maryland has no plans priced on your health, which private providers you can use, what drives cost, and the write-off.

Health insurance in Tennessee for self-employed people: what are your options?

Four doors, not one: a private PPO plan priced on your health, a fixed-benefit plan, the healthcare.gov marketplace with its 2026 subsidy cliff, and a pre-established ERISA group plan. Which private health insurance providers in Tennessee you can use, what drives cost from Nashville to Memphis, and how to tell a good off-marketplace plan from a bad one.

Self-employed health insurance in South Carolina: what are your options?

Four doors, not one: a private PPO plan priced on your health, a fixed-benefit plan, the healthcare.gov marketplace with its 2026 subsidy cliff, and a pre-established ERISA group plan. Which private health insurance providers in South Carolina you can use, what the best individual plan looks like for you, and what drives cost from Charleston to Greenville.

Health insurance in Alabama for self-employed people: what are your options?

Four doors, not one: a private PPO plan priced on your health, a fixed-benefit plan, the healthcare.gov marketplace with its 2026 subsidy cliff, and a pre-established ERISA group plan. Why the off-marketplace doors matter more in Alabama than almost anywhere, which providers you can use, and the Alabama self-employed health insurance deduction.

Health insurance in Pennsylvania for self-employed people: what are your options?

Four doors, not one: a private PPO plan priced on your health, a fixed-benefit plan, Pennie (Pennsylvania's own marketplace) with its 2026 subsidy cliff, and a pre-established ERISA group plan. Which individual providers in PA you can actually use and what drives private health insurance cost per month.

Health insurance in North Carolina for self-employed people: what is the best option?

Four doors, not one: a private PPO plan priced on your health, a fixed-benefit plan, the healthcare.gov marketplace with its 2026 subsidy cliff, and a pre-established ERISA group plan. Which private health insurance companies in North Carolina a self-employed person can use, and what drives cost.

Health insurance in Virginia for self-employed people: what are your options?

Four doors, not one: a private PPO plan priced on your health, a fixed-benefit plan, Virginia's Insurance Marketplace (the state-run exchange) with its 2026 subsidy cliff, and a pre-established ERISA group plan. What drives private health insurance cost in Virginia and which door fits you.

Health insurance in Arizona for self-employed people: what is the best option?

Four doors, not one: a private PPO plan priced on your health, a fixed-benefit plan, the healthcare.gov marketplace with its 2026 subsidy cliff, and a pre-established ERISA group plan. What drives private health insurance cost per month in Arizona, which providers you can use, and a note for people who split the year between two states.

Health insurance in Colorado for self-employed people: what is the best option?

Three doors, not four: a pre-established ERISA group plan you join as a solo owner, Connect for Health Colorado (or the same plans off-exchange, including the Colorado Option), and supplemental layers. Why Colorado limits what can be sold off the marketplace, and how much of the premium you can deduct.

Health insurance in California for self-employed people: how do you get it, and what are your options?

Three doors, not four: Covered California (or the same plans off-exchange), a pre-established ERISA group plan you join as a solo owner, and supplemental layers. Why California limits what can be sold off the marketplace, the state mandate, and why the write-off saves twice.

Health insurance in Ohio for self-employed people: what is the best option?

Four doors, not one: a private PPO plan priced on your health, a fixed-benefit plan, the healthcare.gov marketplace with its 2026 subsidy cliff, and a pre-established ERISA group plan. What actually drives private health insurance cost per month in Ohio, and which door fits which Ohioan.

Health insurance in Michigan for self-employed people: how do you get it, and what is best?

The 4 steps to getting covered when you work for yourself, then the four doors: a private PPO priced on your health, a fixed-benefit plan, healthcare.gov with the 2026 cliff, and a pre-established ERISA group plan. What drives private health insurance cost in Michigan.

Health insurance in New Jersey for self-employed people: how much does it cost, and what are your options?

Three doors: Get Covered NJ (or the same plans off-exchange), a pre-established ERISA group plan on the MagnaCare network, and supplemental layers. Why New Jersey does not price by county or by health, the state mandate, and what that means for a healthy owner.

Health insurance in Indiana for self-employed people: can you get it, and what is best?

Yes, you can. Four doors: a private PPO plan priced on your health, a fixed-benefit plan, the healthcare.gov marketplace with its 2026 subsidy cliff, and a pre-established ERISA group plan. Cheapest vs best, what drives private health insurance cost in Indiana, and which door fits which Hoosier.

Health insurance in Florida for self-employed people: what are your options?

Four doors, not one: a private PPO plan priced on your health, a fixed-benefit plan, the healthcare.gov marketplace with its 2026 subsidy cliff, and a pre-established ERISA group plan. What actually drives the cost per month, and which door fits which Floridian.

Health insurance in Texas for self-employed people: how do you get it, and what are your options?

The 4-step path to coverage when you are the company, why the PPO question matters more in Texas than almost anywhere, and the four doors: private underwritten PPO, fixed-benefit, healthcare.gov, and a pre-established ERISA group plan.

Health insurance in Georgia for self-employed people: what is the best (and cheapest) option?

Cheapest and best are two different plans. A one-table answer by situation, why Georgia Access replaced healthcare.gov, and the four doors for a self-employed Georgian, including the write-off that counts on both the federal and Georgia returns.

Medigap Plan G vs Plan N: which one is better for you? Pros, cons, and the New York twist

The two plans differ on exactly two lines: Plan N's up-to-$20 office and $50 ER copays, and Part B excess charges. Everything else is identical. The premium-difference-divided-by-$20 math, who each plan fits, and why New York's community rating and year-round guaranteed issue change the answer.

Self-Employed Health Insurance Deduction Calculator: how much does health insurance really cost you when you work for yourself?

Your monthly premium, your net profit, your bracket. See the deduction (capped at profit minus half of self-employment tax), the tax savings, and your true monthly cost, plus the eligible-months rule and the subsidy twist. Then the bigger lever: the plan itself.

AI Second Opinion: paste what ChatGPT told you about your health plan

Paste the answer an AI gave you about your health insurance and I read it myself, not a robot. What it got right, what it got wrong, and the question it did not know to ask you. Free, usually back within a business day.

COBRA Cost Calculator: how much does COBRA cost per month, and over the whole stretch?

Pick single, couple, or family, slide to the months you need (18 federal, 36 in New York), and see your monthly COBRA bill and the total. Uses your election notice or the KFF 2025 average plus the 2% fee, then the honest list of what to compare it against.

Who is NOT eligible for the premium tax credit in 2026? The 12 knockouts people find out about at tax time

Married filing separately, a job plan you turned down, Medicare, being claimed as a dependent, using your draw instead of net profit. The IRS checks all of it on Form 8962, and for 2026 there is no cap on what you pay back. The full list, the income traps, and the self-employed line 11 rule.

Is COBRA worth it in New York? What it costs, how long it lasts, and the cheaper alternatives

COBRA is 102% of the full premium, about $793 a month single or $2,294 family at 2025 averages, and it can run 36 months in New York. When it's the right call, when the marketplace beats it, and the third door for healthy people that nobody mentions.

Health insurance broker in Buffalo, NY: what I do, what it costs you (nothing), and why it matters in 2026

Same price as going it alone, by law. What a Buffalo broker actually does: network checks against your doctors, subsidy planning around the cliff, the carriers I compare in Erie County, and the doors NY State of Health never shows you.

NY State of Health vs. using a broker: same price, different outcome

Is it cheaper to buy through the marketplace or a broker? Neither. A side-by-side of what the website shows you, what it doesn't, why 2026 premiums jumped, and how to keep your subsidy without a tax-time surprise.

PPO vs HMO vs EPO vs POS: what is the difference?

One chart, four plan types. Primary care doctor required? Referrals? Out-of-network coverage? Cost? Plus the New York twist and the three questions to ask before you look at a price.

Pre-established ERISA group plans: the New York small-business cheat code

Federal ERISA law overrides community rating, so healthy small businesses and self-employed people can merge into an existing ERISA group for group rates, a true PPO, and a policy they own.

Small business health insurance in Buffalo, NY: the owner-only and under-10 guide, with the 2027 rate-letter math

Western New York carriers asked for 9% to 17% more on small-group plans for 2027, on top of 11% to 15% approved for 2026. What that means in dollars for a 5- and 10-person team, the four doors for a business under 50, who qualifies for Healthy NY and the tax credit, the Nov 15 to Dec 15 window, and two real client stories.

The five buckets of health coverage, explained in plain English

The four ways Americans under 65 get covered, what each does well, where the holes are (health shares are not insurance), and how to combine them.

The 2026 ACA subsidy cliff: why marketplace premiums jumped (and what to do)

How the 400% FPL subsidy cliff works, why premiums jumped in 2026, and what to do if you are over the line.

The “build a house” strategy: how to leave with a check, not a bill

How to combine coverage types so you handle the everyday costs and the catastrophic costs separately.

The unlimited-copay PPO (the “Cadillac plan”) nobody shows you

The private underwritten PPO where in-network care is capped at copays with no coinsurance, who qualifies, who it is not for, and why most brokers never show it.

Why did my health insurance premium go up so much, and what can I actually do about it?

Your letter gave you a percentage and no explanation. Type in what you pay and what the letter says, and see the increase in real dollars per month and per year, plus how yours compares to the 6% the state approved for 2027. Then why community rating means it was never about you, what the DFS actually approved against a 20.6% request, why Western New York runs higher, and the four things to check before you let it auto renew.

Free tools

🧮 Premium Increase Calculator

Your renewal says it is going up. See what that costs per month and per year, whether your increase is in line with the approved 2027 New York average, and the four options before you auto renew.

🧮 Self-Employed Deduction Calculator

Premium, net profit, bracket: your deduction, the tax savings, and what coverage really costs per month when you work for yourself.

🧮 COBRA Cost Calculator

How much does COBRA cost per month, and over 18 months (36 in New York)? Your election notice or the national average, plus the 2% fee.

🧮 2026 Subsidy Cliff Calculator

60 seconds: are you over the line, and do you pass the 8 knockout questions?

🧮 MAGI Calculator for ACA Subsidies

Self-employed? Turn gross receipts, expenses, and household income into the one number the marketplace actually uses, then see it against the 2026 cliff.

🧮 Employer Coverage Affordability Calculator

30 seconds: does your job plan pass the 2026 9.96% test, and can your spouse and kids still get a subsidy (the family glitch fix)?

✅ What health insurance can I get? Quiz

5 questions, 60 seconds, answers never leave your browser.

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