A Second Opinion on Your Health Insurance Plan

Signs your plan needs a second look

• Your premium jumped at renewal.
• You were auto-renewed into a plan you did not choose.
• Your income, household or job changed this year.
• Your doctor left the network, or you are not sure they are in it.
• You chose the plan years ago and have not compared since.
• You are on COBRA and wondering whether to stay.
• Someone sold you a plan by phone and you are not sure what it is.

What I check in a review

1. What kind of plan it is. Marketplace, private major medical, short-term, fixed indemnity, health sharing or a discount card. People are surprised how often they do not know. Each has very different protections.

2. Your income estimate and tax credit. If you are on a Marketplace plan, is your estimate realistic for this year? An estimate that is too low means repaying credit at tax time; too high means you are overpaying each month. For 2027 coverage, the credit stops at 400 percent of the poverty level, $63,840 for one person and $132,000 for four. The subsidy cliff guide explains it.

3. Metal level. Silver plans come with extra cost-sharing help for lower incomes. Bronze plans have been HSA-eligible since 2026. Gold plans suit people who use a lot of care. Many people are on the wrong level for how they use care.

4. Network. Are your doctors, hospital and pharmacy in network? Is it an HMO that needs referrals, and does that work for you? What happens when you travel?

5. Prescriptions. Each drug's tier and cost on the plan, and whether a different plan covers them better.

6. Total cost, not just premium. Premium plus what you would pay in a typical year, with the out-of-pocket maximum as the worst case.

7. The private alternative. If you are healthy and above the subsidy line, a private plan priced on health instead of income may cost less for similar or better coverage.

8. Renewal and timing. When you can change, and what the next renewal is likely to look like.

What people usually find

• An outdated income estimate, leading to a credit that is too big or too small.
• A cheaper plan with the same network, sitting in the same county list.
• A plan that is not really insurance, such as a limited benefit plan sold as major medical.
• A missed private option for a healthy household over the line.
• Nothing wrong at all, which is also worth knowing.

Plans that are not what they seem

Some plans sold by phone or online are not comprehensive insurance. Fixed indemnity plans pay set amounts per day or service. Discount cards are not insurance. Short-term plans exclude pre-existing conditions. Health sharing ministries do not guarantee payment. These can have a place, but they should never be mistaken for a full health plan. If you are not sure what you have, a review will tell you. The short-term versus ACA guide and the health sharing guide explain two of the most common.

When to do a review

• Every October, before open enrollment, which runs November 1, 2026 to January 15, 2027 for 2027 coverage.
• Within days of a life change: a job change, marriage, birth, move or loss of coverage.
• Any time your renewal notice looks wrong.

Three reviews, three outcomes

A Clearwater couple in their early sixties, auto-renewed. Their Marketplace plan had been discontinued and replaced with a plan that dropped their cardiologist. Their income estimate was also two years old. Updating the estimate and choosing a different silver plan in the same county kept the cardiologist and lowered their monthly payment. Nothing about their health or income had changed; only the paperwork had.

A 33-year-old rideshare driver who bought a plan online. What he thought was major medical was a fixed indemnity plan paying set amounts per hospital day. With his income, he qualified for a substantial Marketplace credit. During the next open enrollment he moved to a subsidized silver plan with reduced cost-sharing that cost him less per month and actually covered a hospitalization.

A self-employed consultant on COBRA. She was paying the full COBRA premium for a plan she barely used. She was healthy and over the subsidy line. A private PPO with a national network replaced COBRA the first of the next month, approved before she cancelled.

Questions to ask about any plan you have now

1. Is this plan insurance, and is it ACA-compliant?
2. What is the deductible, and what is the out-of-pocket maximum?
3. Are my doctors and hospital in network today, not just last year?
4. How are my prescriptions covered, and at what tier?
5. If this is a Marketplace plan, is my income estimate current?
6. Is there a plan with the same network that costs less?
7. When can I change it, and what happens if I do nothing?

If you cannot answer most of these from your plan documents, that alone is a reason for a review.

Reviews for families and businesses

For families, I check whether everyone belongs on the same plan, whether children qualify for Florida KidCare or a different plan, and how the family deductible works. For small business owners, I check how the premium flows through the business and whether an HRA for employees would work better than what you have now. The family guide and the employer stipend guide cover those situations.

What it costs

Nothing. I am paid by carriers when someone enrolls, and the premium is the same whether you buy through me or directly. If your current plan is the right one, I will tell you to keep it.

What to send me

1. Your renewal notice or plan summary.
2. Your zip code and the ages of everyone covered.
3. Your income estimate for the year.
4. Your doctors and prescriptions.

I will tell you what you have, whether it fits and what I would change, if anything. Request a review or call or text (786) 218-2384. I review plans for clients in Florida, Texas, Georgia and the other states I am licensed in.