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Your Insurance Detective › Blog
Written and reviewed by Dick Tracy, licensed health insurance broker (NPN 20414610) · New guide most Mondays · Updated September 14, 2026
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.
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.
Self-employedNo 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.
CostsThe 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.
New YorkOne 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.
CostsThe 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.
Amherst NYThere 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.
New YorkNobody 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.
Self-employedOpens 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.
Free toolNot 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.
CaliforniaEvery 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.
New YorkFour 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.
PennsylvaniaTax 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.
MarylandThe 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.
Open enrollmentNovember 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.
Job lossPennsylvania 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.
Save moneyThe 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.
Plans explainedOne 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.
Plans explainedMarketplace, 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.
Job lossCOBRA 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.
Real numbersFrom $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.
Enroll onlineYour 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.
Enroll online"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.
Enroll onlineNo 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.
Enroll onlineNo 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.
Job lossCOBRA 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.
Save moneyHealthcare 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.
Essential PlanThe 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.
New York kidsNew 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.
Niagara Falls NYThree 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.
Claims & billingBilled 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.
Syracuse NYThree 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.
Albany NYYou 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.
Charleston WVWest 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.
Portland MESeasonal 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.
Wilmington DEYour 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.
Lexington KYHorse 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.
Madison WIMadison 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.
Tucson AZTwo 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.
Rochester NYThree 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.
Tampa FLFour 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.
Houston TXFour 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.
Phoenix AZFour 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.
Nashville TNFour 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.
New YorkThree 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.
ConnecticutThree 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.
KentuckyFour 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.
WisconsinFour 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.
West VirginiaFour 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.
MaineThree 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.
DelawareFour 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.
MassachusettsThree 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.
MarylandThree 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.
TennesseeFour 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.
South CarolinaFour 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.
AlabamaFour 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.
PennsylvaniaFour 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.
North CarolinaFour 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.
VirginiaFour 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.
ArizonaFour 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.
ColoradoThree 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.
CaliforniaThree 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.
OhioFour 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.
MichiganThe 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.
New JerseyThree 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.
IndianaYes, 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.
FloridaFour 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.
TexasThe 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.
GeorgiaCheapest 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.
Medicare supplementsThe 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.
Free toolYour 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.
Free toolPaste 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.
Free toolPick 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.
Subsidy trapsMarried 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.
Lost your jobCOBRA 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.
Buffalo, NYSame 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.
Straight answersIs 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.
Plans explainedOne 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.
Small businessFederal 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 businessWestern 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.
Plans explainedThe 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.
2026 changesHow the 400% FPL subsidy cliff works, why premiums jumped in 2026, and what to do if you are over the line.
StrategyHow to combine coverage types so you handle the everyday costs and the catastrophic costs separately.
Plans explainedThe 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.
Free toolYour 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.
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.
Premium, net profit, bracket: your deduction, the tax savings, and what coverage really costs per month when you work for yourself.
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.
60 seconds: are you over the line, and do you pass the 8 knockout questions?
Self-employed? Turn gross receipts, expenses, and household income into the one number the marketplace actually uses, then see it against the 2026 cliff.
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)?
5 questions, 60 seconds, answers never leave your browser.
Pick a slot below and it lands on both our calendars. No phone tag, no hard sell. I educate, you decide.