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2. When to Recommend ACA

There are situations where ACA is the better fit. Know when to say so.

  • Client has significant pre-existing conditions requiring ongoing specialist care, surgeries, or high Rx costs
  • Client qualifies for a substantial subsidy (paying $0–$100/month after tax credits)
  • Client is pregnant or planning to be — maternity coverage is essential on ACA, not available on our plans
  • Client requires mental health or substance use disorder treatment coverage
  • Client is on pain management, blood thinners, or Type 1 diabetes medication — these are ongoing high-cost conditions our plan is not designed for
  • Client has intellectual disabilities such as Down syndrome — the ongoing care requirements are better served by ACA or Medicaid
  • Client cannot pass our underwriting health questions

If the client falls into any of the above categories, do the right thing. Refer them to the ACA marketplace or a broker who specializes in it. Your reputation as an honest advisor is worth far more than one commission.