Individual and Family Health Insurance - Under Age 65
Your health and your family's health coverage is paramount to quality of life and financial independence. Piedra Insurance Concepts allows you access to various insurance carriers and solutions that fit your needs and budget.
A major source of individual/family health insurance outside of the private market would be through a federal or state funded Affordable Care Act (ACA) exchanges; Otherwise known as "Obamacare".
PIC is your go-to authority to solicit the most comprehensive coverage and utilize all offered programs and subsidies available to help ease the financial burden for critical coverage.
ACA Mandated Essential Health Benefit Coverages
No Pre-Existing Conditions Disqualifiers
No Pre-Existing Conditions Disqualifiers
No Pre-Existing Conditions Disqualifiers
Health insurance coverage is obtainable for anyone regardless of any defined pre-existing medical conditions (Diabetes, Cancer, Pregnancy, Etc.)
Preventive and Wellness Services
No Pre-Existing Conditions Disqualifiers
No Pre-Existing Conditions Disqualifiers
Zero costs (regardless of Co-Pays or deductibles) preventive services like immunizations and screening tests.
Emergency Services
No Pre-Existing Conditions Disqualifiers
Ambulatory Patient Services
No approval from insurers needed prior to receiving emergency services at a hospital outside of network - Nor can they charge you more for out of network providers.
Ambulatory Patient Services
Ambulatory Patient Services
Ambulatory Patient Services
Outpatient care received without being admitted to a hospital
Hospitalization
Ambulatory Patient Services
Prescription Drugs
Admitted hospitalization services must be covered such as surgery and overnight stays.
Prescription Drugs
Ambulatory Patient Services
Prescription Drugs
Prescription drug coverage must be included
Pregnancy, Maternity and Newborn Care
Mental Health and Substance Use Disorder Services
Services provided before and during pregnancy as well as care postpartum including breastfeeding support, counseling, and equipment for the duration of breastfeeding.
Mental Health and Substance Use Disorder Services
Mental Health and Substance Use Disorder Services
Behavioral health treatment, such as psychotherapy and counseling.
Mental and behavioral health inpatient services.
Substance use disorder (commonly known as substance abuse) treatment.
Rehabilitative and Habilitative Services and Devices
Rehabilitative and Habilitative Services and Devices
Services and devices to help with injuries, disabilities, or chronic conditions gain, or recover mental and physical skills.
Laboratory Services
Rehabilitative and Habilitative Services and Devices
Coverage for urine, blood and other laboratory services.
Pediatric Services
Including oral and vision care (adult dental and vision coverage are not considered essential health benefits).
Subsidies
In addition to mandated coverages, subsidies are available under certain conditions of which you can rely on PIC to ensure you and your family are compliant:
- Americans with Modified Adjusted Incomes from less than 133% of the Federal Poverty Level (FPL) and up to 400% of FPL are entitled to subsidies. Chart to the right is applicable for year 2026 and provides an estimated amount of subsidy to be expected based on income.
- Subsidies must be applied for and starting plan year 2028 MUST be actively renewed on a yearly basis - PIC will ensure that all covered members are compliant of this requirement.
- Must be advance premium tax credit (APTC) tax compliant for a minimum of 2 years of which subsidies have been received (to be updated to 1 year starting plan year 2028).
- Subsidies are available for lawfully present immigrants who are: Lawful Permanent Residents, Certain Cuban and Haitian immigrants, and COFA migrants.
Click for healthinsurance.org's subsidy FAQ
The PIC Advantage
Guiding Light
The Affordable Care Act has allowed millions of Americans who were unable or previously ineligible for health insurance coverage to now have comprehensive and affordable coverage. Compliance laws change yearly of which Piedra Insurance Concepts will serve as your guiding light to ensure your family is prepared and ready to enact needed coverage.
PIC will guide you through the proper channels and shop for plans that fit your needs and budget as well as provide continued follow-up as your needs adjust throughout the years.
We encourage you to preview plans on your own - Below is a button for personalized access to the Federal Marketplace.
Contact us with any questions or if you are ready to shop and/or enroll!