Do I have to answer medical questions or take a health exam?

No. Plans sold through the ACA Marketplace are guaranteed issue , which means you cannot be denied coverage or charged more due to a pre-existing condition. There are no medical exams or health questionnaires required. You simply select the plan that works best for you — and your coverage begins as early as the first of the following month.

Is financial assistance available to help lower my monthly premium?

Yes! If you don’t have access to affordable employer coverage, you may qualify for a premium tax credit to reduce your monthly premium — and possibly cost-sharing reductions to lower deductibles and copays. These subsidies are based on your household size and estimated income for the year. Most people qualify for some form of assistance, and we can help you estimate your eligibility and apply through Healthcare.gov or your state’s Marketplace.

What types of health insurance plans are available?

Most individual and family plans available through the ACA Marketplace are HMO-style plans . This means you'll typically need to use in-network doctors and hospitals, and get a referral to see a specialist. PPOs, which offer more flexibility, are rarely available in the individual market. All ACA-compliant plans are required to cover essential health benefits , including preventive care, prescription drugs, emergency services, mental health, maternity, and more — but networks and plan details vary by carrier.

How can we get started?

Getting started is easy. We’ll help you gather the necessary information (like employee census and business documentation), walk you through your plan options, and recommend a setup that fits your team and your budget. From there, we handle the paperwork, assist with employee communication, and get your group enrolled on your desired start date.

Does it cost more to use a health insurance agent or broker?

No — there’s no added cost to use a licensed health insurance agent. Carrier rates include commissions whether you use an agent or go direct, so you’re paying for that service either way. By working with an agent, you gain access to expert guidance, personalized plan recommendations, support with enrollment and renewals, and help resolving any issues that may come up. It’s like having a benefits consultant on your team — at no extra charge.

What compliance requirements do employers have when offering benefits?

Employers offering health benefits must comply with a range of requirements, including distributing required notices (like the Summary of Benefits and Coverage), properly handling pre-tax deductions under Section 125 rules, and following federal nondiscrimination laws. Depending on the size of your company, you may also need to provide COBRA or state continuation coverage and file IRS forms like the 1095-C. We’ll help you stay up to date with all applicable rules and take the burden off your plate.

FAQs – Page 2 – JME Insurance

Do I have to answer medical questions or take a health exam?
April 29, 2025Individual & Family FAQs0 min
Is financial assistance available to help lower my monthly premium?
April 29, 2025Individual & Family FAQs0 min
What types of health insurance plans are available?
April 29, 2025Individual & Family FAQs0 min
How can we get started?
April 29, 2025Employer FAQs0 min
Does it cost more to use a health insurance agent or broker?
April 29, 2025Employer FAQs0 min
What compliance requirements do employers have when offering benefits?
April 29, 2025Employer FAQs0 min

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