Health Insurance

Here at Martinez Insurance Agency, Inc. we dedicate ourselves to finding you the best and most affordable health insurance coverage for your needs through Marketplace.

Call: 786-601-2136
Call/Text: 786-650-5421

Finding the right health insurance policy can be stressful whether it’s for an individual or an entire family, especially when it comes to balancing affordability and coverages.

Medical costs continue to rise, and without proper insurance, even a minor emergency can create a major financial setback in your life. Our agent will make sure you can continue your routine checkups or attend a specialist consultation without hurting your wallet.

THE DIFFERENT TYPES OF HEALTH INSURANCE PLANS

Health Maintenance Organization (HMO):

  • Lower-cost plans with a focus on preventive care.

  • Requires a Primary Care Physician (PCP) for referrals to specialists.

  • Must stay in-network (out-of-network care is not covered).

  • Low copays (typically $10–$25 per visit) and no deductibles in most cases.

Exclusive Provider Organization (EPO):

  • Similar to HMOs but no PCP requirement.

  • Must stay in-network (except emergencies).

  • No referrals needed for specialists within the network.

Point of Service (POS):

  • Hybrid of HMO and PPO plans.

  • Requires aPCP for referrals but allows out-of-network care (with higher costs).

  • Lower copays in-network (around $10), but deductibles and coinsurance apply for out-of-network care.

Preferred Provider Organization (PPO):

  • More flexibility—no PCP or referrals needed.

  • Higher premiums but lower costs when staying in-network.

  • Out-of-network care is partially covered (typically 70–80%).

  • Annual out-of-pocket maximums protect against high costs.

All plans offered in the Marketplace cover these 10 essential health benefits:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)

  • Emergency services

  • Hospitalization (like surgery and overnight stays)

  • Pregnancy, maternity, and newborn care (both before and after birth)

  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

  • Prescription drugs

  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)

  • Laboratory services

  • Preventive and wellness services and chronic disease management

  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

We’ll even help you pick a health plan with or without dental benefits. If you pick a health plan without dental benefits, you can still get a separate dental plan.

Health plans with dental coverage:

Some Marketplace health plans have dental coverage. You can see which plans include dental coverage when you compare them. If a health plan includes dental, the premium covers both health and dental benefits.

Separate dental plans:

In some cases, separate dental plans are offered. You can see them when you shop for plans in the Marketplace.

If you pick a separate dental plan, you’ll pay a separate premium. This is in addition to the premium you pay for your Marketplace health plan.

Vision coverage:

A health benefit that at least partially covers vision care, like eye exams and glasses. All plans in the Health Insurance Marketplace include vision coverage for children. But Only some plans include vision coverage for adults.

Confused about Marketplace and how to enroll? You’re not alone. Our Marketplace-certified agent will simplify the process by:

  • Explaining Eligibility: Determine if you qualify for subsidies, Medicaid, or cost-sharing reductions. We will also verify other eligibility requirements, for instance, if you live in the United States, if you’re a U.S. Citizen or National, or a lawfully present non-citizen, and if you’re not incarcerated.

  • Comparing Plans: Between Bronze, Silver, Gold and Platinum tiers, we’ll match you with coverage that fits your budget and healthcare needs.

  • Special Enrollment Help: If there is a life changing situation like a job loss, getting married, or having a new baby, we can fast-track your application.

DISCLAIMER: If you have Medicare coverage, you can't enroll in a Marketplace health or dental plan.