Questions, answered plainly.

A premium tax credit is a federal tax credit that lowers your monthly Marketplace premium. For 2027 coverage, it is generally available to households with income between 100% and 400% of the federal poverty level who buy a plan through HealthCare.gov and do not have access to affordable job-based coverage, Medicaid, or Medicare. Eligible households are expected to pay between 2.15% and 10.22% of income for the benchmark silver plan, and the credit covers the rest of that plan's cost.

Sources. irs.gov, irs.gov, healthcare.gov

Yes. The enhanced premium tax credits that capped costs for higher earners expired at the end of 2025, and as of September 2026 Congress has not enacted an extension. That brings back the 400% "cliff": for 2027 coverage, households above 400% of the poverty level, about $63,840 for one person or $132,000 for a family of four, generally get no premium tax credit at all. If your income is close to that line, careful income planning can make a large difference.

Sources. irs.gov, aspe.hhs.gov

Cost-sharing reductions are extra savings that lower your deductible, copays, and out-of-pocket maximum, and you only get them on a silver plan. For 2027, they apply to household income from 100% to 250% of the poverty level (up to $39,900 for one person or $82,500 for a family of four). Depending on income, a silver plan is upgraded to cover about 94%, 87%, or 73% of typical costs, with out-of-pocket maximums as low as $4,000 for one person.

Sources. healthcare.gov, ecfr.gov, cms.gov

Marketplace savings for 2027 plans use the 2026 federal poverty guidelines: $15,960 for one person, $21,640 for two, $27,320 for three, and $33,000 for a family of four in Texas, Oklahoma, and the other 46 contiguous states. You compare those numbers to your expected 2027 household income. Medicaid uses the current year's figures, which is why the two programs can show slightly different dollar cutoffs.

Sources. aspe.hhs.gov, healthcare.gov

The Marketplace uses modified adjusted gross income for everyone in your tax household, which starts with adjusted gross income from your federal tax return and adds back untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest. Self-employment income counts after business expenses. You estimate what you expect to earn in 2027, not what you earned last year. We help you build a realistic estimate, because the credit is settled on your tax return.

Source. healthcare.gov

Report it to the Marketplace as soon as you can so your advance credit can be adjusted. The credit is reconciled on your federal tax return, and starting with 2026 tax years there is no longer any cap on paying back excess advance credits: if you received more than you qualified for, you repay the full difference. If your income drops, reporting it may raise your credit or make you eligible for Medicaid or cost-sharing reductions.

Sources. healthcare.gov, congress.gov

Open Enrollment for 2027 coverage on HealthCare.gov runs from November 1, 2026 through January 15, 2027, and both Texas and Oklahoma use HealthCare.gov. Pick a plan by December 15 for coverage that starts January 1; plans chosen from December 16 through January 15 start February 1. A 2025 federal rule would have shortened this window, but after a June 2026 court ruling CMS confirmed the traditional dates for this season.

Sources. cms.gov, healthcare.gov, cms.gov

A Special Enrollment Period lets you sign up for or change a Marketplace plan outside Open Enrollment after a qualifying life event, such as losing other health coverage, moving, getting married, or having or adopting a baby. You usually have up to 60 days after the event to pick a plan, and you may be asked to prove the event, especially loss of coverage. Enrolled members of federally recognized tribes can enroll or change plans once a month all year.

Sources. healthcare.gov, cms.gov, ecfr.gov

The most common ones are losing other health coverage, getting married or divorced, having a baby, adopting or placing a child in foster care, and moving permanently to a new ZIP code or county. Losing coverage covers a job loss, aging off a parent's plan, and losing Medicaid or CHIP. Death of a household member, gaining citizenship, and release from incarceration also count. You generally have 60 days after the event, and for a loss of coverage you can apply up to 60 days before it happens. A change in income by itself is not a qualifying life event.

Sources. healthcare.gov, ecfr.gov

No. The monthly enrollment period for people with income at or below 150% of the poverty level ended in August 2025 and is not available for 2026 or 2027. A 2025 federal law also bars premium tax credits for anyone enrolling through an income-based enrollment period that is not tied to a life event. Low-income households can still apply for Medicaid any time, use a regular life-event enrollment period, or enroll during Open Enrollment.

Sources. cms.gov, cms.gov, congress.gov

Yes. You can apply for Medicaid or CHIP any time; there is no enrollment season. In Oklahoma, SoonerCare covers adults 19 to 64 with income up to 138% of the poverty level, plus children, pregnant women, and other groups. Texas has not expanded Medicaid to most low-income adults, so adults there usually qualify only in specific categories, while children may qualify for Medicaid or CHIP. If your HealthCare.gov application shows you may qualify, your information can be sent to your state Medicaid agency.

Sources. healthcare.gov, oklahoma.gov, healthcare.gov

They are the three ways a plan asks you to share the cost of your care. The deductible is what you pay out of pocket before the plan starts paying for most services. A copay is a fixed amount for a covered service, for example $30 for an office visit. Coinsurance is a percentage of the cost of a covered service, for example 20%. All three count toward your out-of-pocket maximum; your monthly premium does not. Preventive care such as annual checkups and recommended screenings is covered before the deductible on every Marketplace plan.

Sources. healthcare.gov, healthcare.gov, healthcare.gov, healthcare.gov

The metal level tells you how you and the plan split costs, not the quality of care. On average, a bronze plan pays about 60% of covered costs, silver about 70%, gold about 80%, and platinum about 90%. Lower metal levels usually mean lower premiums but higher costs when you get care. Silver is the only level with cost-sharing reductions, so if your income is under 250% of the poverty level, a silver plan often gives the most value.

Sources. healthcare.gov, healthcare.gov

An HMO usually covers care only from its network, except emergencies, and often requires a primary care doctor's referral to see a specialist. An EPO also covers only in-network care, except emergencies, but typically does not require referrals. A PPO covers out-of-network care too, at a higher cost. In short, an HMO generally costs less in exchange for a tighter network and referrals, and a PPO costs more for the flexibility. In Texas and Oklahoma, the plan types available vary by county and insurer, so we show you exactly which networks are offered in your ZIP code.

Sources. healthcare.gov, healthcare.gov, healthcare.gov, healthcare.gov

Check each plan's provider directory and drug list (formulary) before you enroll, and confirm with your doctor's office that they take that specific plan, not just the insurance company. Networks can differ between plans from the same insurer, and they can change from one year to the next. Bring us a list of your doctors, hospitals, and medications, and we will check every plan you are considering against it.

Sources. healthcare.gov, healthcare.gov

For 2027 Marketplace plans, the federal maximum out-of-pocket limit is $12,000 for one person and $24,000 for a family, up from $10,600 and $21,200 in 2026. Many plans set lower limits, and cost-sharing reductions lower it further, to as little as $4,000 for one person. Premiums do not count toward this limit, and neither does out-of-network care on plans that do not cover it.

Sources. cms.gov, healthcare.gov

Yes, more easily than before. Starting in 2026, federal law treats every bronze and catastrophic plan bought through the Marketplace as an HSA-compatible high-deductible health plan, so you can open and fund a health savings account with one. Before 2026, only plans specifically designed as HSA-eligible qualified. HSA contributions are tax-deductible and can be used tax-free for qualified medical costs, so this can pair well with a bronze plan.

Sources. congress.gov, healthcare.gov, healthcare.gov

Catastrophic plans are available to people under 30 and to people who qualify for a hardship or affordability exemption. They have low premiums and very high deductibles, cover preventive care and at least three primary care visits a year before the deductible, and premium tax credits cannot be applied to them. A 2027 federal rule that would have widened catastrophic eligibility is on hold because of a court order, so we confirm current eligibility before recommending one.

Sources. healthcare.gov, uscode.house.gov, cms.gov

Yes. Enrolled members of federally recognized tribes and ANCSA shareholders can get zero or limited cost-sharing on any metal level and can enroll or change Marketplace plans once a month, all year. Special Medicaid and CHIP protections also apply to people eligible for IHS, tribal, or urban Indian health services. Our EnrollNative team covers these protections in depth at [EnrollNative.com](https://enrollnative.com/faq), including documents, income rules, and how your plan works with IHS.

Sources. healthcare.gov, ecfr.gov

No. Accident, critical illness, cancer, and similar policies are limited-benefit supplements that pay set amounts for specific events or diagnoses. They are not major medical insurance, do not have to cover the ACA's essential health benefits, and cannot be bought with premium tax credits. As the Texas Department of Insurance explains, these policies carry disclosures saying they supplement, and do not replace, major medical coverage. They work best on top of an ACA or employer plan.

Sources. tdi.texas.gov, tdi.texas.gov

Accident insurance pays a cash benefit when you are hurt in a covered accident, such as a fracture, dislocation, emergency room visit, or hospital stay, based on the schedule in the policy. The money usually goes to you, not the doctor, so you can use it for your deductible, lost income, or travel. It does not pay for illnesses. It can be useful for active families or anyone with a high-deductible plan.

Source. tdi.texas.gov

Critical illness insurance pays a lump sum if you are diagnosed with a covered condition listed in the policy, commonly a heart attack, stroke, or certain cancers. The benefit is paid to you and can cover your deductible, household bills, or time away from work. Covered conditions, waiting periods, and pre-existing condition limits vary a lot between policies, so read the definitions closely. We compare them in plain language before you buy.

Sources. tdi.texas.gov, tdi.texas.gov

Cancer insurance, a type of specified disease policy, pays benefits only if you are diagnosed with cancer; it will not pay for any other illness. Benefits may be a lump sum or payments for treatments like chemotherapy, radiation, or hospital stays. It can help with costs your health plan does not cover, such as travel, lodging, and lost income. Whether it is worth it depends on your family history, savings, and how high your plan's deductible is.

Source. tdi.texas.gov

For children, dental coverage is an essential health benefit, so it is available either inside a health plan or as a separate dental plan. Adult dental and vision coverage is not required, so most adults buy separate dental or vision plans. Stand-alone dental plans have their own premiums, deductibles, and annual maximums, can have waiting periods for adults, and through the Marketplace are bought alongside a health plan.

Sources. healthcare.gov, tdi.texas.gov

An ICHRA, which HealthCare.gov now calls a CHOICE Arrangement, lets an employer reimburse employees tax-free, up to a set monthly amount, for individual health insurance premiums and qualified medical costs instead of offering a traditional group plan. Employers of almost any size can offer one if they have at least one employee who is not an owner or an owner's spouse. Employees must enroll in their own individual coverage, such as a Marketplace plan, and employers can set different amounts for different employee classes.

Source. healthcare.gov

An employee cannot get a premium tax credit for any month they are covered by the ICHRA. If the offer is "affordable," the employee cannot claim a credit even by opting out; for 2027, it is affordable if the employee's cost for the lowest-cost silver plan in their area, after the reimbursement, is no more than 10.22% of household income. If it is unaffordable, the employee may opt out and use the premium tax credit instead. Employers must give written notice 90 days before the plan year starts.

Sources. healthcare.gov, irs.gov

A QSEHRA, or qualified small employer HRA, lets a business with fewer than 50 full-time-equivalent employees that does not offer a group health plan reimburse employees tax-free for health insurance and medical costs. For plan years beginning in 2026, reimbursements are capped at $6,450 for self-only coverage and $13,100 for family coverage; the 2027 limits have not been published yet. If the QSEHRA is affordable, the employee cannot get a premium tax credit; if it is not, the credit is reduced by the QSEHRA amount.

Sources. irs.gov, irs.gov

A traditional small-group plan can be a good fit when you want one shared plan, predictable enrollment, and coverage your team recognizes. Small-group plans must cover essential health benefits, insurers set minimum participation rules, and businesses with fewer than 25 full-time-equivalent employees that buy through SHOP may qualify for the Small Business Health Care Tax Credit for up to two consecutive years. We compare group, ICHRA, and QSEHRA costs for your actual team before you decide.

Sources. healthcare.gov, healthcare.gov

A licensed health insurance broker helps you compare plans, estimate your savings, check doctors and prescriptions, and enroll, then stays available when you have questions, need to report changes, or renew. Navigators also give free, unbiased enrollment help; a broker can go further and recommend specific plans. Both are trained and registered with the Marketplace every year, and neither one charges you. What you get from a broker is a licensed person who can compare the options with you and say which one they would pick.

Sources. healthcare.gov, healthcare.gov

We are a licensed health insurance brokerage, and we help individuals, families, and small businesses across Texas and Oklahoma compare and enroll in coverage that fits both their needs and their budget. It costs you nothing, because insurance companies pay us, not our clients. One licensed advisor stays with you from the first conversation through enrollment and renewal, so you are not starting over with a call center every time something changes. We will also tell you honestly when the coverage you already have is the better deal.

Sources. healthcare.gov, tdi.texas.gov

Our help is genuinely free to you: insurance companies pay us a commission when you enroll, and HealthCare.gov confirms you will not pay anything additional for enrolling with an agent or broker. The plan itself is a separate question. Marketplace plans have a monthly premium, and depending on your income, household size, age, ZIP code, and the plan you choose, a premium tax credit can cover part of that premium and sometimes all of it. We show you the real monthly number for each plan before you decide anything.

Sources. healthcare.gov, healthcare.gov, irs.gov

Not necessarily, and we will say so if your current plan is the better deal. If your employer's offer is considered affordable under federal rules, you generally cannot get a premium tax credit on a Marketplace plan, which usually makes the job-based plan the cheaper choice for you. It is still worth a look when family coverage through work is expensive, when your doctors are out of that plan's network, or when you are weighing a spouse's plan against your own. We compare the real numbers side by side.

Sources. healthcare.gov, irs.gov

Both. We work with individuals and families on Marketplace coverage, and with small businesses that want to start offering benefits, replace a plan that is not working, or simply switch brokers. For employers, that includes traditional small-group plans and reimbursement arrangements such as a CHOICE Arrangement (formerly called an ICHRA) or a QSEHRA. We compare what each approach would actually cost for your team, with your real census and your real ZIP codes, before you commit to one.

Sources. healthcare.gov, healthcare.gov

Nothing. You do not pay us to compare or enroll in coverage. Like other licensed agents and brokers, we are paid commissions by insurance companies when you enroll, and HealthCare.gov confirms you will not pay anything additional by enrolling with an agent or broker. Your premium for a Marketplace plan is the same whether you enroll with us, on your own, or with a navigator.

Source. healthcare.gov

You can look up any insurance agent's license with the Texas Department of Insurance, the Oklahoma Insurance Department, or the national NIPR license lookup. RedHealth Advisors LLC is a licensed Texas insurance agency (NPN 22110493), and Ryan Hutson (NPN 21321807) is its licensed agent. Our licensing page lists each license number with a link to check it. We encourage every client to check, because working with a licensed advisor protects you if something goes wrong.

Sources. tdi.texas.gov, nipr.com