FAQ

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These are health insurance plans offered through the Health Insurance Marketplace, created by the Affordable Care Act (ACA).

• Federally-Facilitated Marketplaces (FFMs) are run by the federal government through HealthCare.gov.

• State-Based Marketplaces (SBMs) are operated by individual states.

Both types of marketplaces offer financial assistance—such as premium tax credits and cost-sharing reductions—for individuals and families who qualify based on their income.

Example: Pennsylvania operates its own state-based marketplace called Pennie, which helps residents find coverage and get financial help to lower monthly premiums.

A PHI and PII consent form is a document that gives permission for Carpenter Collective and our trusted third-party partners to collect, use, and share your Protected Health Information (PHI) and Personally Identifiable Information (PII).

• PHI refers to any health-related information tied to your identity, such as medical history, health insurance details, or treatment records.
   
• PII includes personal data like your name, date of birth, Social Security number, or contact information.
   

By signing this form, you're allowing us to use this information solely to provide the services you've requested—such as insurance consultations, plan comparisons, or enrollment support—while complying with HIPAA and data privacy regulations. You can revoke your consent at any time.

If you haven’t received your health, dental, or vision insurance card within 7–10 business days after enrollment, here are a few steps you can take:

1. Check Your Email: Some carriers send digital ID cards by email or through their member portal.
    
2. Log Into the Insurance Carrier's Website: You may be able to download a digital version of your card or request a physical one.
    
3. Contact the Insurance Carrier Directly: Call the member services number of your insurance provider to request a new card or confirm mailing status.
    
4. Reach Out to Us: If you're unsure who your carrier is or need help accessing your card, contact us at [Insert Contact Info] and we’ll be happy to assist.
    

Note: Physical cards are issued by third-party insurance carriers. While we help with enrollment and plan selection, we do not print or mail the cards directly.

Once your health insurance application is approved, your insurance company will send you a welcome packet with instructions on how to make your first premium payment. Most insurance carriers offer several payment options, including:

• Online through the insurer’s website or mobile app
• By phone using a debit or credit card
• By mail with a check or money order
• Automatic bank draft (AutoPay)
   

It's important to make your first payment on time to activate your coverage. If you need help locating your payment portal or setting up AutoPay, feel free to contact us—we're here to help!

If you miss a health insurance premium payment, your policy may not be immediately terminated, but there is a grace period. Most plans, especially those purchased through the Marketplace with a premium tax credit, offer a 30 to 60 -day grace period to catch up on payments. If full payment is not received by the end of this period, your coverage may be terminated retroactively to the last paid month.

To avoid losing coverage, it’s important to act quickly. If your plan is managed by a third-party provider or insurer, please contact them directly or reach out to us at Carpenter Collective so we can help guide you through your next steps and possibly explore other options.

 In most cases, yes—your policy is set to automatically renew to ensure you don't experience a lapse in coverage. However, renewals depend on the specific insurance carrier and policy type. You will typically receive a renewal notice before your current policy ends, outlining any changes in coverage or premiums. 

If you work with a third-party agent or planner through us, we recommend reviewing your renewal options with them to confirm your coverage still meets your needs. 

Yes, an increase in your income can affect the amount of assistance you receive through the Healthcare Marketplace. The financial help you get—known as a Premium Tax Credit—is based on your estimated annual income and household size. If your income goes up, you may qualify for less assistance, which can result in a higher monthly premium.

To avoid any unexpected costs at tax time, it’s important to report income changes as soon as possible to the Marketplace. This helps keep your premium and coverage accurate throughout the year.

Yes, it can. The assistance you receive is called a Premium Tax Credit (PTC), and it’s based on your estimated income and household size for the year. If your actual income ends up being higher or lower than what you reported when you applied, the IRS may adjust the credit when you file your federal tax return.

• If you received too much assistance during the year, you may have to pay some or all of it back.
   
• If you received too little, you might get an additional credit when you file or tax refund.
   

That’s why it’s important to report any income or household changes to the Marketplace as soon as possible, so your premium assistance stays accurate and your tax filing goes smoothly.

Need help? We can review your income and tax household to make sure you're receiving the right amount of assistance.

Yes. If you receive a Premium Tax Credit to help lower your monthly health insurance premiums, you must file a federal tax return each year—even if you don’t normally file due to low income.

You’ll need to file using Form 1095-A, which is sent to you by the Health Insurance Marketplace. On your tax return, you’ll also need to complete Form 8962 to reconcile the amount of premium assistance you received with your actual income.

If you don’t file your taxes or fail to include these forms, you could lose your eligibility for these savings in the future, even if your income still qualifies you.

 If your prescriptions aren’t covered by your current health plan, you still have several options:

1. Generic Alternatives: Ask your doctor or pharmacist if there is a generic or alternative medication that is covered by your plan.
    
2. Formulary Exceptions: You may be able to request a formulary exception, which asks your insurance company to cover a medication that’s not typically included.
    
3. Prescription Discount Programs: Use manufacturer coupons, pharmacy discount cards, or programs like GoodRx to reduce the cost of your medication.
    
4. Patient Assistance Programs: Many pharmaceutical companies offer financial help or free medication to those who qualify.
    
5. Plan Review: During open enrollment or if you qualify for a special enrollment period, you can explore switching to a plan with broader prescription coverage.
    

We’re happy to help you review your plan or explore these options. Contact us to schedule a free consultation.

 Once your health insurance application is approved and your first payment is processed, most insurance carriers mail your physical medical ID cards within 7 to 21 business days. 

However, many plans offer digital ID cards that you can access immediately through the carrier's website or mobile app. If you need help accessing your digital card, feel free to contact us—we're happy to assist! 

 Once your health insurance plan is active, you can access your digital medical card through your insurance provider's member portal or mobile app. Here's how:

1. Log in to your insurance provider member portal.
    
2. Navigate to the “ID Cards” or “Documents” section.
    
3. Download or email your digital ID card. Many insurers allow you to save it to your phone or digital wallet for easy access.
    

If you enrolled through us and need help locating your provider's portal or accessing your digital card, feel free to contact Carpenter Collective—we're happy to assist!

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 If you’re looking for affordable healthcare coverage outside of the government-run healthcare marketplace (such as Healthcare.gov), there are several options you can explore:

• Direct Purchase from Insurance Companies: Many insurance carriers offer plans directly to consumers on their websites or through licensed agents. Sometimes these plans may offer competitive pricing or different coverage options than marketplace plans.
   
• Health Sharing: These are cooperative programs where members share healthcare costs. They are not insurance but can be an affordable alternative for some people.

• Short-Term Health Insurance: These plans provide temporary coverage at a lower cost but usually have limited benefits and may not cover pre-existing conditions. They can be a short-term solution while you find a more comprehensive plan.
   
• Employer-Sponsored Plans: If you’re employed, check if your employer offers group health insurance, which often has better rates due to group purchasing power.
   
• Medicaid or State Programs: Depending on your income and state, you might qualify for Medicaid or other state-specific healthcare programs that provide low-cost or free coverage.
   
• COBRA Coverage: If you recently left a job with health benefits, COBRA lets you keep your employer’s coverage for a limited time by paying the full premium yourself.
   
• Community Health Clinics and Assistance Programs: Some local clinics offer low-cost or sliding scale services, and nonprofit programs may help with medical costs.
   

It’s important to carefully review coverage details and costs to ensure the plan meets your healthcare needs and budget. Working with a licensed insurance agent can help you explore all available options and find the best fit.

Most healthcare marketplace plans include limited or no vision and dental coverage for adults. However, some plans may offer pediatric dental and vision benefits as part of the Essential Health Benefits required for children under 19.

If you want comprehensive vision or dental coverage for yourself as an adult, you will likely need to purchase a separate dental and/or vision plan either through the marketplace or directly from an insurance provider.

 Most healthcare marketplace plans primarily cover medical (health) services such as doctor visits, hospital stays, prescriptions, and preventive care. Dental and vision coverage are usually not included in these standard health plans.

• Health Coverage: Included in all marketplace plans.
   
• Dental Coverage: Often available as a separate dental plan that you can add when signing up, especially for adults. For children under 19, dental coverage is often included automatically.
   
• Vision Coverage: Typically not included in standard health plans. Vision insurance is usually purchased separately through standalone vision plans.
   

If you want dental or vision coverage, you may need to enroll in additional plans offered through the marketplace or purchase separate insurance outside the marketplace.

 Whether you need to select a primary care doctor (PCP) depends on the type of healthcare plan you choose.

• HMO (Health Maintenance Organization) plans: Yes, you typically must choose a primary care doctor. Your PCP will coordinate your care and provide referrals to specialists when needed.
   
• PPO (Preferred Provider Organization) plans: No, you usually don’t have to select a PCP. You can see any provider in the network without a referral.
   
• Other plans: Requirements can vary, so it’s best to check your specific plan details or contact your insurance provider.
   

Selecting a primary care doctor can help streamline your care and ensure you have a go-to professional for your health needs.

Yes, you can. Most insurance policies and services we offer include a free-look period — typically 10 to 30 days — during which you can review your policy or service contract and cancel for a full refund if it doesn’t meet your needs.

After that period, you can still cancel your policy or service at any time. We’ll help you understand any potential consequences (like loss of coverage or pro-rated charges) and assist you with the cancellation process to make it smooth and stress-free.

If your needs have changed, we may also be able to adjust your coverage of services instead of canceling completely. Just reach out — we’re here to help!

Yes, you may qualify for programs that help reduce your Medicare premiums, deductibles, copayments, and other out-of-pocket costs. Depending on your income and resources, you might be eligible for:

• Medicare Savings Programs (MSPs) – Help pay Medicare Part A and/or Part B premiums and may cover deductibles and copays.
   
• Extra Help (Low-Income Subsidy) – Reduces costs for Medicare Part D prescription drug coverage.
   
• State and local assistance programs – Some states offer additional support beyond federal programs.
   

At Carpenter Collective, we can help review your eligibility and guide you through the application process to ensure you're getting all the benefits you're entitled to.

 Yes, Medigap and Medicare Supplement Insurance are the same thing. The term “Medigap” is just a nickname for Medicare Supplement Insurance. These are private insurance plans designed to help cover some of the out-of-pocket costs that Original Medicare (Part A and Part B) doesn't cover—such as deductibles, copayments, and coinsurance.

So, whether you hear “Medigap” or “Medicare Supplement,” they both refer to the same type of policy.

You may qualify for Medicare if you meet one of the following criteria:

• Age 65 or older and a U.S. citizen or permanent legal resident who has lived in the U.S. for at least five years.
   
• Under age 65 with a qualifying disability, and you’ve received Social Security Disability Insurance (SSDI) for at least 24 months.
   
• Any age with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS/Lou Gehrig’s disease).
   

In most cases, if you or your spouse have worked and paid Medicare taxes for at least 10 years, you may qualify for premium-free Part A coverage. Other parts of Medicare (like Part B, Part C, and Part D) may have premiums.

If you’re unsure about your eligibility or how to apply, we’re here to help! Contact us for personalized guidance.

Medicaid eligibility is based on several factors including income, household size, disability status, and other circumstances. Generally, you may qualify if you are:

• Low-income individual or family
   
• Pregnant
   
• A child or teenager
   
• An adult aged 65 or older
   
• Living with a disability
   
• Caring for someone who is elderly or disabled
   

Eligibility rules can vary by state, so it’s important to check with your state’s Medicaid office or speak with a licensed advisor to understand your specific situation. Carpenter Collective can help you explore your eligibility and guide you through the application process.