# The Insurance Guide: full content companion

> The independent, honest guide to what health insurance really costs, including when not to buy. Every figure on the site traces to official data: CMS Marketplace public use files (plan year 2026), IRS Rev. Proc. 2025-25 applicable percentages, HHS federal poverty guidelines, and KFF benchmark premiums for state-based exchanges. Estimates are free and require no email.

## Site overview

The Insurance Guide is the independent, honest guide to what health insurance really costs, including when not to buy. The site computes real 2026 marketplace numbers for any U.S. household: enter a ZIP code, ages, and income and see actual filed premiums (not averages), the estimated premium tax credit, COBRA-versus-marketplace totals, special enrollment deadlines, and side-by-side plan comparisons, all free, with no email required for any estimate. Alongside the calculators, the site publishes 306 state-level guide pages covering five qualifying life events (losing job coverage, turning 26, moving, having a baby, getting married) and self-employed coverage, plus three downloadable worksheets. Every figure traces to official data: CMS Marketplace public use files for plan year 2026, the IRS Rev. Proc. 2025-25 applicable percentage table, HHS federal poverty guidelines, and KFF benchmark premiums for state-based exchanges. Where the data is an estimate rather than a filed rate, the site says so on the page.

## Tools

### Subsidy estimator: https://theinsurance.guide/calculator/subsidy-estimator

Purpose: Estimates the 2026 premium tax credit and real monthly plan costs by metal tier for any household.

Inputs: ZIP code, ages of household members, household size, expected annual income.

Returns: Estimated premium tax credit and price ranges by plan tier, shown instantly with no signup. Email is only needed for the full plan-by-plan table.

Methodology: Premiums come from the official CMS Marketplace public use files for plan year 2026: actual filed rates by plan, age, and rating area, filtered to plans offered in your county. The subsidy follows the IRS formula: the benchmark second-lowest-cost Silver premium minus your income multiplied by the 2026 applicable percentage for your income bracket, per Rev. Proc. 2025-25. For states that operate their own exchange (SBEs), we use a state-average benchmark estimate and note that in the results. All figures are estimates, not quotes. Final premiums are set at enrollment through your state or federal marketplace.

Honest limits: SBE states show rougher state-average benchmark estimates rather than filed plan-level rates, and the results say so. Estimates are not quotes.

### COBRA vs marketplace: https://theinsurance.guide/calculator/cobra-vs-marketplace

Purpose: Compares the real cost of electing COBRA against a subsidized marketplace plan for the rest of 2026, with an honest verdict either way.

Inputs: The COBRA premium from your election notice, ZIP code, household ages, expected annual income, and the months remaining in 2026.

Returns: Total cost of each option for the rest of the year, plus an honest verdict that calls out when continuity (deductible progress, provider networks) makes COBRA the better buy despite a higher premium.

Methodology: Your COBRA cost is the premium you enter, the real number from your election notice, multiplied by the months you choose. The marketplace side uses the official CMS Marketplace public use files for plan year 2026, the same plan and rate data behind HealthCare.gov: we take the cheapest Silver plan in your area, subtract your estimated premium tax credit per the IRS formula in Rev. Proc. 2025-25, and multiply by the same months. For states that operate their own exchange, we use a state-average benchmark estimate and say so in the results. The verdict compares premiums only; deductible progress and provider networks are called out separately, because they can outweigh a premium gap. All figures are estimates, not quotes.

Honest limits: The verdict compares premiums only; deductible progress and networks are flagged separately. SBE states use state-average benchmark estimates. Estimates are not quotes.

### SEP deadline checker: https://theinsurance.guide/calculator/sep-checker

Purpose: Tells you whether your 60-day special enrollment window is open, upcoming, or closed, with the exact deadline, the documents to gather, and where to enroll in your state.

Inputs: The qualifying life event, the date it happened, and your state.

Returns: Window status (open, upcoming, or closed), the exact deadline date, the documents the marketplace may request, your state marketplace name and enrollment link, and any verified state-level rule differences.

Methodology: The windows come from the federal Special Enrollment Period rules as published on HealthCare.gov for plan year 2026: losing job-based coverage and aging off a parent’s plan open a window that runs from 60 days before the coverage loss to 60 days after it; a qualifying move opens a 60-day window after the move, with a prior-coverage requirement set by federal regulation (45 CFR 155.420). The math is plain calendar-day counting from the date you enter. State marketplace names, enrollment links, and Open Enrollment dates come from each marketplace’s published 2026 materials, and we flag the verified state-level differences. This checker reports the window. Only the marketplace itself can confirm your eligibility, and it may ask for documents before coverage can be used.

Honest limits: The checker reports the window by calendar-day counting; only the marketplace itself can confirm eligibility, and it may request documents before coverage can be used.

### Plan comparison: https://theinsurance.guide/calculator/compare-plans

Purpose: Puts up to three marketplace plans side by side (premium, after-subsidy price, deductible, out-of-pocket maximum) with a shareable link that reopens the exact comparison.

Inputs: ZIP code, household ages, household size, expected annual income, and up to three plan selections from your area.

Returns: For each plan: monthly premium, price after your estimated subsidy, medical deductible (with any separate prescription-drug deductible shown alongside rather than hidden), and out-of-pocket maximum, plus a copyable share link.

Methodology: Every number comes from the official CMS Marketplace public use files for plan year 2026, the same plan and rate data behind HealthCare.gov. Premiums are the non-tobacco rates for your rating area and ages; deductibles and out-of-pocket maximums come from the plan attributes file, and when a plan reports a separate prescription-drug deductible we show it alongside the medical deductible rather than hiding it in a single number. The after-subsidy price subtracts your estimated premium tax credit, computed per the IRS formula in Rev. Proc. 2025-25 from the second-lowest-cost Silver plan in your area, except Catastrophic plans, which cannot use the credit and are shown at full price. When the federal files do not report a value, we print a dash instead of guessing. States that run their own exchanges are not in the federal files, so we say so instead of faking a plan list. All figures are estimates, not quotes. Confirm final prices where you enroll.

Honest limits: Premium tax credits cannot be applied to Catastrophic plans, so they are shown at full price; Catastrophic plans are limited to people under 30 or those with a hardship or affordability exemption. Plan-level comparison is not available for states that run their own exchanges. Estimates are not quotes.

### True cost of care: https://theinsurance.guide/calculator/total-cost-of-care

Purpose: Shows what a marketplace plan really costs in a year (a year of after-subsidy premiums plus what you would actually pay toward your expected care under each plan’s deductible, coinsurance, and out-of-pocket maximum), because the lowest-premium plan is often not the cheapest.

Inputs: ZIP code, household ages, expected annual income, and how much care you expect (a healthy year, a typical year, a heavy year, or your own dollar figure).

Returns: A true annual cost for every plan in your area, sorted cheapest first; when a pricier-premium plan turns out cheaper in total, the tool says so and shows the dollar difference.

Methodology: Premiums, deductibles, and out-of-pocket maximums come from the official CMS Marketplace public use files for plan year 2026, the same plan and rate data behind HealthCare.gov. The after-subsidy price subtracts your estimated premium tax credit, computed per the IRS formula in Rev. Proc. 2025-25 from the second-lowest-cost Silver plan in your area, except Catastrophic plans, which cannot use the credit. To turn expected care into a dollar figure it applies a representative coinsurance rate for each metal level (about 40% at Bronze down to 10% at Platinum), drawn from each tier’s actuarial value, and counts in-network preventive care as free per the ACA. This now covers the federal marketplace and most state-run exchanges. All figures are estimates, not quotes.

Honest limits: The care-cost figure is a planning estimate (real plans set their own copays and coinsurance by service), and a couple of state exchanges (Colorado and Maryland) are not in the public files yet, so plan-level cost detail is not available there. Estimates are not quotes.

### Metal tier recommender: https://theinsurance.guide/calculator/metal-tier-recommender

Purpose: Recommends a marketplace metal tier from four plain questions about your expected care and risk tolerance, then pulls the cheapest real plan in that tier and the contrast tier so you can check the recommendation against actual dollars.

Inputs: Four questions (expected use, preference for fewer surprises, regular medication or ongoing condition, and whether you could absorb a sudden $5,000 bill), plus ZIP code, household ages, and expected annual income.

Returns: A recommended tier with the transparent point-by-point reasoning, plus the true annual cost of the cheapest plan in the recommended tier and in the contrast tier; when the cheaper-premium tier would cost less, the tool points that out, and it flags when your income unlocks Silver cost-sharing reductions.

Methodology: The scoring is transparent and shown with the result: each answer adds a fixed number of points toward richer coverage, with a high combined score landing on Gold, the all-Bronze pattern on Bronze, and everything in between defaulting to Silver, which for incomes up to 250% of the federal poverty level also unlocks cost-sharing reductions. The real numbers use the official CMS Marketplace public use files for plan year 2026, subtract the estimated premium tax credit per the IRS formula in Rev. Proc. 2025-25, and add expected care priced with a representative coinsurance for each metal level. All figures are estimates, not quotes.

Honest limits: The care-cost figure is a planning estimate (real plans set their own copays by service), and for the couple of state exchanges not in the public files yet (Colorado and Maryland) the tool shows the tier and subsidy estimate but not a plan-level table. Estimates are not quotes.

### FPL calculator: https://theinsurance.guide/calculator/fpl-calculator

Purpose: Shows where your income falls on the federal-poverty-level scale (the single number Medicaid and the marketplace use) and the exact dollar lines that decide Medicaid eligibility, premium tax credits, cost-sharing reductions, and the 400% subsidy cliff for your household.

Inputs: Annual income, household size, and state.

Returns: Your income as a percentage of the federal poverty level, plus the dollar cutoffs for your household: 138% for Medicaid expansion, 100–400% for premium tax credits, 250% for cost-sharing reductions, and the 400% cliff.

Methodology: The tool uses the U.S. Department of Health and Human Services poverty guidelines, applying the prior year’s guidelines to the upcoming plan year as the marketplace does, so 2026 eligibility uses the 2025 guidelines ($15,650 for one person in the 48 contiguous states and D.C., plus $5,500 per additional member, with higher tables for Alaska and Hawaii). Your FPL percentage is your income divided by your household’s guideline, and the band cutoffs come from the Affordable Care Act. The 400% subsidy cliff returns in 2026 after the enhanced premium tax credits expired at the end of 2025. This is an educational estimate.

Honest limits: Your actual eligibility is determined by the marketplace and your state Medicaid agency using your verified income, not by this estimate.

### Am I overpaying: https://theinsurance.guide/calculator/am-i-overpaying

Purpose: Compares your current monthly premium to the cheapest comparable marketplace plan in the same metal tier after subsidy, and gives a straight answer, including the one most tools won’t: when you’re already priced fairly and the right move is to do nothing.

Inputs: Your current monthly premium, the metal tier you’re on, ZIP code, household ages, and expected annual income.

Returns: A verdict: overpaying (more than about 15% above the comparable plan, with the yearly gap shown), about right (within 15%), or already a good deal (below it), measuring price within a metal tier, not benefits.

Methodology: The tool pulls every plan in your rating area from the official CMS Marketplace public use files for plan year 2026 (the same data behind HealthCare.gov), finds the lowest-premium plan in your metal tier, and subtracts your estimated premium tax credit, computed per the IRS formula in Rev. Proc. 2025-25 from the second-lowest-cost Silver plan, to get its net monthly price (Catastrophic plans are shown at full price). It then compares that to the premium you entered using a roughly 15% threshold. This covers the federal marketplace and most state-run exchanges. All figures are estimates, not quotes.

Honest limits: The comparison is like-for-like on metal tier, so it measures price, not network, drug coverage, or deductible; for the couple of state exchanges still missing from the public files (Colorado and Maryland) it compares against a rough state-average benchmark Silver plan. Estimates are not quotes.

### HSA & FSA tax savings: https://theinsurance.guide/calculator/hsa-fsa-savings

Purpose: Estimates the tax savings from contributing pre-tax to an HSA or health FSA (the federal income tax you avoid, plus the FICA payroll tax a paycheck-deducted HSA skips) without hardcoding the contribution limits, so the math never goes stale.

Inputs: Your contribution amount, income, filing status, and whether the HSA is deducted from your paycheck.

Returns: The estimated federal income tax you keep (your contribution times your marginal rate), plus the 7.65% FICA payroll tax saved on a payroll-deducted HSA; the estimate scales with whatever contribution you enter.

Methodology: The tool places your income in the 2026 federal income-tax brackets from IRS Rev. Proc. 2025-32 to find your marginal rate, then multiplies your contribution by that rate to estimate the income tax you avoid. For a payroll-deducted HSA it adds the 7.65% FICA employee payroll tax (6.2% Social Security plus 1.45% Medicare), which an employer-routed HSA skips and a personal one generally doesn’t. The contribution limits, set by the IRS and changed yearly, are deliberately not hardcoded. This is not tax advice.

Honest limits: The federal brackets apply to taxable income but the tool uses the income you enter (usually gross), which can slightly overstate the rate; it also leaves out state income tax, so actual savings may run higher. Confirm current IRS limits and your eligibility before contributing.

### Coverage gap finder: https://theinsurance.guide/calculator/coverage-gap-finder

Purpose: Turns your needs into a checklist of what to actually verify before enrolling, framed honestly so you don’t worry about benefits the ACA already guarantees: every marketplace plan covers the ten essential health benefits, so the real gaps are structural: network, drug formulary, out-of-network coverage, and adult dental and vision.

Inputs: Answers to seven quick questions about your care needs and situation.

Returns: A checklist of specific items to verify on any plan you’re considering (checking a provider directory, looking up a drug in the formulary, comparing out-of-pocket maximums), with each item tied to one of the structural gaps.

Methodology: This is an education tool, not a plan lookup: it doesn’t read your plan’s documents. It starts from how ACA coverage works: every marketplace plan must cover the ten essential health benefits (prescription drugs, mental health and substance-use care, maternity and newborn care, and more, per HealthCare.gov), so those are rarely the real gap. Pediatric dental and vision are essential benefits, but adult dental and vision generally are not. Each “yes” answer maps to a structural gap and adds a matching item to your checklist. Final coverage details are in each plan’s Summary of Benefits and its provider and drug directories.

Honest limits: The checklist is educational and general: it doesn’t read your specific plan, so confirm covered benefits, networks, and drug formularies in a plan’s official documents before you enroll.

### Embeddable widget: https://theinsurance.guide/embed

Add the free 2026 ACA subsidy calculator to any site with three lines of HTML: no API key, no account. The widget computes estimated premium tax credits and plan-tier price ranges for any ZIP code; income is used only in the visitor’s browser and never transmitted.

The widget renders in a shadow DOM so its styles stay isolated from the host page, and it carries a credit link back to The Insurance Guide. The estimate step sends ZIP and household ages to the rate API to look up plan data; contact details are collected only if the visitor opts in to follow-up from a licensed agent.

## Quizzes & self-assessments

### Insurance IQ quiz: https://theinsurance.guide/quiz/insurance-iq

Ten multiple-choice questions answered one at a time, with instant feedback and a short explanation after each, then a score out of ten and a grade band (9–10 "Insurance pro", 7–8 "Solid", 5–6 "Getting there", below 5 "Worth a refresher"). Every question and explanation is drawn from the site’s content-verification log, where each claim was checked against an authoritative source (HealthCare.gov, the IRS, the U.S. Department of Labor, or CMS) and each explanation links to the matching /learn glossary entry. Results carry a shareable link that encodes only the score. This is educational: it measures how well you understand the rules, not whether a particular plan is right for you.

### Coverage health score: https://theinsurance.guide/coverage-score

A transparent additive model: everyone starts at a baseline of 50, and each answer adds or subtracts a fixed number of points. Having coverage adds 20 (none subtracts 30), a plan that fits expected usage adds 15 (one that doesn’t subtracts 15), a sign of overpaying subtracts 15, each known gap subtracts 10 down to a 30-point floor, being able to absorb a worst-case out-of-pocket year adds 15, and using free preventive care adds 5, capped at 0–100. The results page lists every contribution, so the number is never a black box, and links to the overpayment check, coverage gap finder, true-cost calculator, and subsidy estimator to address weak spots. It is built only from your answers, so it can’t see your actual policy, network, or formulary: an educational self-assessment and conversation starter, not advice or a verdict on your plan.

## Agent tools (MCP)

Endpoint: https://mcp.theinsurance.guide (streamable HTTP transport, no authentication required, 20 requests per 60 seconds per IP).

Every tool response is wrapped in a honesty envelope: source ("The Insurance Guide"), the canonical page URL for the answer, planYear (2026), a fixed disclaimer ("All figures are estimates for plan year 2026, not quotes or guarantees. The Insurance Guide is independent and is not HealthCare.gov or a government agency."), and a caveats array carrying any estimate-roughness or state-variation notes.

Server card: https://theinsurance.guide/.well-known/mcp/server-card.json

### estimate_subsidy

Estimate the 2026 ACA premium tax credit and marketplace plan prices for a household.

Inputs: zip (5-digit string), ages (array of integers 0-120, 1-10 members), household_size (integer 1-12, must be at least the number of ages listed), annual_income (expected 2026 household modified adjusted gross income, in dollars).

Returns: mode (ffm or sbe), state, stateName, medicaidExpansion, fplPct, subsidyMonthly (dollars per month, null if ineligible or Medicaid range), slcsp (benchmark premium), tiers (Silver/Gold/Bronze/Platinum min-max where plan-level data exists). SBE states return null tiers and a rougher benchmark estimate, flagged in caveats.

### check_sep_window

Check whether a 2026 Special Enrollment Period window is open, upcoming, or closed for a qualifying life event.

Inputs: event (one of: lost-job, turning-26, moving, new-baby, marriage), event_date (ISO date YYYY-MM-DD), state (two-letter US state code), had_prior_coverage (boolean, required when event is moving or marriage: whether those events qualify depends on it).

Returns: status (open, upcoming, closed, or does-not-qualify-without-prior-coverage), opensOn, deadline, daysLeft, docsNeeded, coverageStart, enrollThrough (marketplaceName, enrollUrl, phone), and openEnrollment dates when the window is closed. Moving and marriage without prior coverage return the honest exceptions answer, no invented deadline.

### compare_cobra

Compare the total cost of keeping COBRA against the best subsidized marketplace Silver plan over a chosen number of months.

Inputs: same household fields as estimate_subsidy, plus cobra_monthly (full COBRA premium from the election notice, in dollars), months (integer 1-12), deductible_met (boolean, whether the current plan's deductible is already met this year).

Returns: verdict (marketplace-cheaper, cobra-cheaper, or too-close), cobraTotal, marketplaceTotal, savings, marketplaceNetMonthly, marketplaceBasis, subsidyMonthly, continuityCase (true when deductible_met: adds the continuity caveat about deductible progress and provider networks).

## Markdown

Content pages return markdown when requested with Accept: text/markdown (shipping in SP7, alongside the MCP server). The response carries Content-Type: text/markdown and an X-Markdown-Tokens header with an approximate token count. Interactive calculator pages return a one-paragraph description and a link to the full tool rather than a markdown rendering of the interactive UI.

## Learn: glossary and comparisons

Hub: https://theinsurance.guide/learn

Plain-English definitions of the 63 health insurance terms that decide what you pay (deductible, coinsurance, out-of-pocket maximum, metal tiers, premium tax credit, HSA, FSA, and more), plus 22 side-by-side comparisons (PPO vs HMO, HSA vs FSA, bronze vs silver, copay vs coinsurance, COBRA vs marketplace, and others). Each entry is short, sourced, and links to a calculator.

The glossary covers 63 terms at /learn/[term], each with a plain-English definition, a worked example, why it matters, and the common point of confusion, carrying DefinedTerm schema. The 22 comparisons at /learn/[a]-vs-[b] each pair a side-by-side table with an honest when-each-wins breakdown and a bottom line, carrying FAQPage schema. Every entry cross-links to related terms and to the relevant calculator. The full list is on the hub.

## Special enrollment events: verified 2026 rules

Each event below has a full set of state guide pages. Facts are drawn from the site’s verified rule seed (sourced to HealthCare.gov, federal regulation at 45 CFR 155.420, and each state marketplace’s published materials).

### Losing job-based coverage

State pages: 51 pages at /enroll/lost-job/[state], for example https://theinsurance.guide/enroll/lost-job/texas.

Window: from 60 days before the event to 60 days after it.

Losing health insurance through an employer, including if you quit or get fired, qualifies you for a Special Enrollment Period. You can apply if you lost qualifying coverage in the past 60 days or expect to lose it in the next 60 days. Voluntarily dropping coverage you have as a dependent does not by itself qualify, and missing the 60-day window means waiting for the next Open Enrollment unless another qualifying life event occurs.

The load-bearing rule is the COBRA interplay: you do not have to take COBRA; declining it and enrolling in a marketplace plan within 60 days of losing job-based coverage keeps your Special Enrollment Period. Once you elect COBRA, you can switch to a marketplace plan outside Open Enrollment only if your COBRA coverage is running out, you must pay the full cost because your former employer stopped contributing, or you are still within 60 days of losing the job-based coverage. COBRA can charge up to 102 percent of the plan’s full cost.

Coverage start: Marketplace coverage takes effect the first day of the month after job-based coverage ends and a plan is selected; it cannot start the same day the old coverage ends. If coverage was already lost, picking a plan by the end of the month starts coverage the first of the next month (e.g., lose coverage March 7, pick a plan by March 31, coverage starts April 1). If applying before a future loss, coverage starts the first day of the month after the old coverage ends.

Documents in brief: Documents are requested only if your post-application Marketplace Eligibility Notice says so; you have 30 days after picking a plan to send them. Acceptable proof includes an insurer cancellation letter or premium bill, an employer letter confirming the coverage end, a letter about COBRA coverage, or pay stubs showing a health-coverage deduction that ended in the past 60 days.

State variations: no verified state-level differences beyond the federal rule.

### Turning 26 and leaving a parent's plan

State pages: 51 pages at /enroll/turning-26/[state], for example https://theinsurance.guide/enroll/turning-26/texas.

Window: from 60 days before the event to 60 days after it.

When your coverage ends depends on the kind of plan your parent has, not on your birthday. If your parent has a Marketplace plan, you can stay on it until coverage ends December 31 of the year you turn 26, even if you turn 26 mid-year. You then enroll in your own plan during Open Enrollment. If your parent has a job-based plan, coverage usually ends during or shortly after the month you turn 26, and aging off it is a loss of qualifying coverage that opens a Special Enrollment Period from 60 days before the loss to 60 days after.

The load-bearing rule is the December-31-versus-birthday-month split: a parent’s Marketplace plan carries you to December 31 of your birthday year, while a parent’s job-based plan ends during or shortly after your birthday month; the employer’s benefits office states the exact date. Declining COBRA on the parent’s job-based plan and enrolling in a Marketplace plan within 60 days keeps your Special Enrollment Period; electing COBRA means paying the full premium plus an administrative fee.

Coverage start: If you enroll before you lose the parent's coverage, your new Marketplace plan can start as soon as the first day of the month after you lose coverage. If you enroll after you lose coverage, your new plan can start the first day of the month after you pick a plan.

Documents in brief: Same loss-of-coverage process as other coverage losses: documents only if the eligibility notice asks, 30 days after picking a plan to send them. Acceptable proof includes an insurer letter or premium bill showing the coverage end date, a letter from the parent’s employer confirming when dependent coverage ends, or a letter about COBRA coverage.

State variations:

- New York: the Age 29 law gives young adults aging off a fully insured New York group policy the option to independently purchase continued coverage through the parent’s policy through age 29, elected within 60 days of the date dependent coverage would otherwise end. This is a state continuation option through the parent’s plan, not a change to the Marketplace SEP window.

### Moving to a new state or county

State pages: 51 pages at /enroll/moving/[state], for example https://theinsurance.guide/enroll/moving/texas.

Window: 60 days after the event, with no apply-ahead window.

Moving to a new home in a new ZIP code or county can qualify you for a Special Enrollment Period, but only if you had qualifying health coverage (minimum essential coverage) for one or more days during the 60 days before the move. Moving only for medical treatment or staying somewhere for vacation does not qualify. You must pick a plan within 60 days after the move; HealthCare.gov documents no advance-report window for moves.

The load-bearing rule is the prior-coverage requirement: you must prove you had qualifying coverage for at least one day during the 60 days before the move. The exceptions are living in a foreign country or U.S. territory before the move, membership in a federally recognized Tribe or ANCSA Corporation, or living where no qualifying Marketplace coverage was available. COBRA counts as qualifying prior coverage for the move SEP.

Coverage start: Your coverage start date is based on when you pick a plan, and you can't use coverage until your documents (if requested) confirm your eligibility and you pay the first premium. Under the federal effective-date rules (45 CFR 155.420(b)), a plan selected after the move takes effect the first day of the month following plan selection; if the plan is selected on or before the day of the move, coverage takes effect the first day of the month following the move.

Documents in brief: If the eligibility notice asks, you must send two kinds of documents: proof of the move (bills or statements showing the new address, a USPS change-of-address confirmation, a lease or mortgage, or a government letter) and proof of prior coverage (a letter from an insurance company, employer, including COBRA, or a government health program like Medicaid or CHIP).

State variations:

- Massachusetts: Health Connector policy NG-5 explicitly allows a permanent move to be reported up to 60 days before the event, an advance window HealthCare.gov does not advertise for moves.

### Having or adopting a baby

State pages: 51 pages at /enroll/new-baby/[state], for example https://theinsurance.guide/enroll/new-baby/texas.

Window: 60 days after the event, with no apply-ahead window.

Having a baby, adopting a child, or having a child placed with you for foster care in the past 60 days opens a Special Enrollment Period with the most generous start date in the Marketplace: coverage starts retroactively on the date of birth (or the day of the adoption or foster care placement), even if you enroll up to 60 days afterward. Being pregnant does not by itself qualify on HealthCare.gov (the birth does), so there is no apply-ahead window for this event.

The load-bearing rule is the retroactive start: coverage can start the day the baby was born even when the plan is picked up to 60 days later. If you would rather not pay premiums back to the birth date, you can ask the Marketplace Call Center for a later start. For existing Marketplace enrollees the scope is limited: you can add the baby to your current plan or enroll the baby separately in any plan, but the rest of the household generally cannot change plans until Open Enrollment. Job-based plans must allow at least 30 days after a birth or adoption to request enrollment, with coverage effective on the date of birth.

Coverage start: Coverage starts the day the baby was born (or the day of the adoption or foster care placement), retroactive even if you pick the plan up to 60 days later. If you'd rather not pay premiums back to the birth date, HealthCare.gov says you can call the Marketplace Call Center to request that your coverage start later; under the federal effective-date rules (45 CFR 155.420(b)(2)(i)) the Exchange may let you elect the first of the month following plan selection or a regular prospective date instead.

Documents in brief: Documents only if the eligibility notice asks, 30 days after picking a plan to send them. For adoption, foster placement, or a court order, acceptable proof includes an adoption letter or record, foster care papers, a court order, or a legal-guardianship document; HealthCare.gov publishes no separate document list specifically for a birth.

State variations:

- New York: pregnancy itself is a qualifying event. A pregnant individual may enroll at any time after the pregnancy is certified by a licensed health care practitioner, with coverage effective the first of the month of certification.
- Massachusetts: Health Connector policy NG-5 makes birth, adoption, or foster placement effective on the date of the event or the first day of the following month, and allows broader plan changes after a qualifying event than HealthCare.gov.
- California: Covered California states that the entire family can use the special enrollment period to enroll in coverage, not just the baby.

### Getting married

State pages: 51 pages at /enroll/marriage/[state], for example https://theinsurance.guide/enroll/marriage/texas.

Window: 60 days after the event, with no apply-ahead window.

Getting married in the past 60 days qualifies you for a Special Enrollment Period, but generally at least one spouse must have had qualifying health coverage (minimum essential coverage) for one or more days during the 60 days before the marriage. Two people who were both uninsured cannot create an enrollment opportunity just by marrying. The 60 days start on the wedding day; there is no apply-ahead window.

The load-bearing rule is the one-spouse prior-coverage requirement, with the same exceptions as the move SEP (foreign country or U.S. territory residence, Tribal or ANCSA membership, or no qualifying coverage available where you lived). Marriage also gets an accelerated start date: coverage takes effect the first day of the month after you pick a plan no matter what day of the month you pick it, but it is not retroactive to the wedding date.

Coverage start: Marriage gets an accelerated start date: coverage takes effect the first day of the month after you pick a plan, no matter what day of the month you pick it (the usual mid-month cutoff doesn't apply; 45 CFR 155.420(b)(2)(ii) requires the first day of the month following plan selection). HealthCare.gov puts it simply: pick a plan by the last day of the month and your coverage can start the first day of the next month. Coverage is not retroactive to the wedding date.

Documents in brief: Documents only if the eligibility notice asks, 30 days after picking a plan to send them. Acceptable proof of the marriage includes a marriage certificate, marriage license, official public record, a signed marriage affidavit, or a religious document showing the names and the date.

State variations:

- California: Covered California extends this event to entering a domestic partnership, and describes it without the one-spouse prior-coverage condition that HealthCare.gov applies.
- Massachusetts: Health Connector policy NG-5 lists marriage as a qualifying event without stating the prior-coverage condition; marriage cannot be reported in advance.

## Self-employed coverage

State pages: 51 pages at /health-insurance/self-employed/[state], for example https://theinsurance.guide/health-insurance/self-employed/california.

Self-employed people with no employees use the individual marketplace. No LLC, business license, or formal structure is required. Two channels route financial help their way: a premium subsidy scaled to expected annual income, and the self-employed health insurance deduction for the premiums themselves.

The deduction is above-the-line: premiums paid for yourself, your spouse, and your dependents come straight off your income whether or not you itemize. Two limits apply: the deduction cannot exceed your net self-employment profit, and no deduction applies for any month you were eligible for an employer-subsidized plan, including a spouse’s.

The deduction and the subsidy interact in a loop: the subsidy is based on modified adjusted gross income, the deduction lowers that income, a lower income can raise the subsidy, and a changed subsidy changes the premiums actually paid, which changes the deduction. The IRS publishes an iterative calculation for exactly this situation, and tax software handles it automatically; the practical takeaway is to claim both and let the software converge.

Income estimation is the part that takes honest judgment. The marketplace wants expected net profit for the calendar year, after business expenses, not gross revenue. Advance subsidies are reconciled on the tax return: earning more than estimated means repaying some or all of the excess, so the better habit is updating the estimate whenever real income changes rather than lowballing for a cheaper monthly premium.

One pairing worth pricing: an HSA-eligible high-deductible plan plus a health savings account. Contributions are tax-deductible, the balance grows untaxed, and withdrawals for qualified medical costs are untaxed too. Contribution limits are set by the IRS each year, so check the current figures. For low expected medical use and uneven income this is often the strongest total package; for a high-use year, run the total-cost math first.

## Downloadable guides

### The COBRA decision, three numbers (worksheet): https://theinsurance.guide/guide/cobra-worksheet

A paper worksheet for the COBRA decision. Inside: three fill-in boxes (the COBRA premium from the election notice, the estimated marketplace premium after subsidy, and deductible progress toward this year’s limit); a comparison grid that totals cost for the rest of the year rather than just monthly premiums; a when-COBRA-wins checklist covering mid-treatment continuity, a met deductible, and network access; and the two 60-day clocks: when to elect COBRA and when the marketplace special enrollment window opens and closes.

### Self-employed health coverage playbook: https://theinsurance.guide/guide/self-employed-playbook

A playbook for freelancers, sole proprietors, and independent contractors. Inside: the three-number method for estimating modified adjusted gross income when net profit fluctuates; the section 162(l) above-the-line deduction with its profit-cap and employer-offer limits and the circular interaction with the subsidy; HSA pairing with its eligibility rules and the honest counter-case for a high-use year; a four-quarter re-estimation calendar keyed to the estimated-tax schedule; and the premium-versus-total-cost comparison across metal tiers, including cost-sharing reductions on Silver plans.

### Turning-26 coverage checklist: https://theinsurance.guide/guide/turning-26-checklist

A coverage-handoff checklist for anyone aging off a parent’s plan. Inside: a deadline table (a parent’s Marketplace plan ends December 31 of the year you turn 26; a job-based plan ends during or shortly after the birthday month); the 60-day special enrollment window and why enrolling before the loss date avoids a gap; a six-step action checklist from finding the plan type to enrolling inside the window; the COBRA comparison; and a plain-English vocabulary box covering deductible, out-of-pocket maximum, and premium versus total cost.

### 2026 subsidy income eligibility chart: https://theinsurance.guide/guide/subsidy-income-chart

A one-page reference that converts the abstract "percent of the federal poverty level" into dollars. Inside: a table of annual income by household size against the key poverty-level lines (100%, 138%, 150%, 250%, and 400%) using the 2025 HHS poverty guidelines in force for 2026 coverage for the 48 contiguous states and DC; a note that Alaska and Hawaii use higher guidelines; and a reminder that the income that matters is the household’s modified adjusted gross income for the whole calendar year, not a single month’s pay. Find your household size in the rows, then read where your annual income falls across the columns.

### Employer vs. marketplace decision grid: https://theinsurance.guide/guide/employer-vs-marketplace

A side-by-side grid for anyone weighing a job-based plan against a marketplace plan (starting a job, leaving one, or sizing up an offer). Inside: the fixed comparison factors (who pays the premium and how the employer share and pre-tax treatment work; how the premium tax credit fills the gap between a benchmark Silver plan and a set share of income); the affordability and employer-offer rule that quietly decides marketplace subsidy eligibility for many households; and honest markers for when each side genuinely wins rather than a blanket recommendation.

### Denied claim appeal kit: https://theinsurance.guide/guide/appeal-kit

A kit for challenging a denied claim or a refused service. Inside: what a denial actually means and why it is only the plan’s stated position; the two stages federal law guarantees for non-grandfathered plans: an internal appeal inside the company, then an external review by an independent reviewer the company does not control; the deadlines that govern each stage; a note that grandfathered plans predating March 2010 may be exempt so coverage should be confirmed; and a fill-in letter to start the internal appeal.

### New parent coverage checklist: https://theinsurance.guide/guide/new-parent-checklist

A checklist for adding a new baby to coverage. Inside: the 60-day special enrollment window that birth, adoption, or foster placement opens, with the unusually forgiving rule that coverage can reach back to the day of the event; why pregnancy alone does not open the window in most states; the two paths (a job-based plan versus a marketplace plan) and how to sort which applies; and a what-to-do-and-when action list keyed to the 60-day clock.

## Updated for 2026, and the honest caveats

All content on this site is written and verified for plan year 2026. All figures are estimates for comparison, not quotes: actual premiums, subsidies, and eligibility are determined at enrollment through your state or federal marketplace. The Insurance Guide is independent: not HealthCare.gov, a state marketplace, an insurer, or a government agency. Nothing on the site is tax advice. Confirm deduction and HSA specifics with a tax professional or current IRS publications.

Data provenance:

- CMS Marketplace public use files, plan year 2026 (filed plan and rate data behind HealthCare.gov)
- IRS Rev. Proc. 2025-25 (2026 applicable percentage table for the premium tax credit)
- HHS federal poverty guidelines (2025, used for 2026 coverage-year eligibility)
- KFF average benchmark premiums (state-based-exchange states where the PUF has no data)

Contact: privacy@theinsurance.guide