Coverage that
actually covers you.
Self-employed, on a 1099, retiring before 65, or leaving a job that carried your family's coverage? Those are the situations that send people looking for their own health plan, and they all come with their own rules. Which path fits depends on your household, your income and who needs covering. I'll help you work that out, then find coverage that fits from multiple carriers.
The four numbers that decide
what a plan really costs.
Every health plan is a trade-off between these four numbers. Understand them, and comparing plans stops feeling like guesswork. The credit you may qualify for is worked out separately — how the premium tax credit actually works.
Premium
What you pay monthly
The fixed amount you pay every month to keep your coverage active — whether or not you use it. The lowest premium is not automatically the cheapest plan once you factor in the numbers below.
Deductible
What you pay first
The amount you pay out of pocket for covered care before the plan starts sharing costs. For ACA-compliant plans, many in-network preventive services are covered before the deductible.
Copays & Coinsurance
What you pay per visit
Your share of costs once coverage kicks in — a flat copay for a doctor visit or prescription, or a percentage (coinsurance) of larger bills.
Out-of-Pocket Max
Your in-network ceiling
For in-network covered care, the most you pay in a plan year through deductibles, copays and coinsurance. Premiums, non-covered care and out-of-network costs generally do not count toward it. It is the number that defines your financial exposure — and where cheap-looking plans can hide real risk.
If meeting that deductible or out-of-pocket maximum in a bad year is the part that worries you, some supplemental products pay fixed benefits for covered events that can help with eligible out-of-pocket expenses. They work alongside major medical coverage, not instead of it, and benefits depend on the policy. If you are weighing a plan that pays scheduled amounts as your main coverage instead, read fixed benefit health plans first — it is a different decision with different stakes.
Three paths to coverage.
One that fits your situation.
Where you buy coverage matters as much as which plan you pick. Here's the honest version of each path.
Marketplace /
ACA Plans
Plans purchased through healthcare.gov with the full set of ACA protections: preexisting conditions covered, essential health benefits included, and premium tax credits that lower your monthly cost if your income qualifies. For most individuals and families, this is the starting point — and where getting the subsidy estimate right pays off.
Off-Marketplace
Individual & Family
The same kind of individual and family coverage bought directly from a carrier rather than through healthcare.gov. Premium tax credits are available only through the Marketplace, so an off-Marketplace plan means paying full price — which can still make sense if your income rules out a subsidy. Either way the work is the same: matching the metal tier, the network and the drug coverage to how your family actually uses care.
Short-Term
Coverage
A possible bridge for gaps — between jobs, waiting for other coverage to start, or after a missed enrollment window. Premiums can be lower, but the trade-offs are real: applications can be declined, preexisting conditions are typically excluded, and benefits are more limited. It may be worth considering for a temporary gap after you understand its limits and confirm it fits your health needs.
When you can enroll,
without the fine print.
Health insurance runs on enrollment windows. Here are the three that matter — and if you're losing coverage through work, leaving a job opens one of them.
Every Fall:
Open Enrollment
Open Enrollment typically begins November 1 — the annual window when anyone can enroll in or switch Marketplace plans for the coming year. Dates and deadlines can change, so confirm the current schedule at HealthCare.gov before enrolling.
Life Changes:
Special Enrollment
Losing employer coverage, marriage, divorce, a new baby, or a permanent move can open a special enrollment window, depending on the event and circumstances — a move, for instance, generally also requires that you had qualifying coverage before it. Timing is limited, so if your situation just changed it is worth checking early.
Year-Round:
Bridge Options
Short-term plans can be purchased any time of year for coverage gaps. They come with real limitations, but when you need something between now and your next enrollment window, it's better than going uncovered.
Wherever you are
in the decision.
Most people land on health coverage from a specific situation, not from the top. Start with the one that sounds like yours.
Leaving a job?
What happens to your health insurance when you leave a job
COBRA, a Marketplace plan, or a spouse’s plan — what each one actually costs you and how long you have to decide.
Read thisWhat will I pay?
How the ACA premium tax credit actually works
Why the sticker price is rarely what you pay, and what the credit is worked out from.
Read thisShort-term plan?
Is short-term health insurance ever a good idea?
An honest look at what these plans do and do not cover before you rely on one.
Read this2027 rates
NC’s 2027 Marketplace rates: when you’ll actually know
Which numbers are still moving, who reviews them, and what is worth doing before Open Enrollment.
Read this
Why Work With Me
I built my practice on one principle: you deserve an advisor who puts your needs first — every time.
How health coverage works
in North Carolina
The Affordable Care Act is federal, but which programs you can actually use is decided at the state level — and North Carolina's answer changed recently.
North Carolina uses healthcare.gov
Some states run their own marketplace with their own website and their own enrollment dates. North Carolina does not — individual and family plans here are bought through the federal Marketplace at healthcare.gov. Open Enrollment typically begins November 1, and because dates and deadlines can change it is worth confirming the current schedule at HealthCare.gov before enrolling. Outside that window you generally need a qualifying life event — losing job-based coverage, moving, marrying, or having a baby — though whether one applies depends on the event and circumstances.
Medicaid expanded here in 2023
On December 1, 2023 North Carolina extended Medicaid to adults ages 19 through 64 with household income up to 138% of the federal poverty level. Before then the state had a gap where people earned too much for Medicaid and too little for much Marketplace help. If you were told years ago that you did not qualify for anything, that answer may be out of date — the income limits are published byNC Medicaid and update annually.
One application covers everyone
A household does not have to land on a single plan. Children may qualify for NC Medicaid or CHIP while a parent takes a Marketplace plan, and one spouse can be on employer coverage while the rest of the family is not. The Marketplace application can assess eligibility for Marketplace savings and may send eligible household members to the state for Medicaid or CHIP review, which is why it is worth applying as a household even when you expect only some of you to qualify.