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What’s In Store For Obamacare?

As we quickly approach the end to Trump’s 100 days in office (April 29, 2017), many are curious as to where we stand when it comes to Obamacare AKA The Affordable Care Act.  At the beginning of his campaign, Trump made a lot of promises and proclamations about repealing Obamacare.  Since the election, the republicans has toned down their stance.

What Plans Does the New Administration Have for Obamacare?

The Republicans recently revealed what their big plan is when it comes to The Affordable Care Act.  One of the most glaring changes in their proposal is the name given to Obamacare.  Their proposal changes the name from The Affordable Care Act to The American Care Act.  Some of the other changes we may see under the new Administration include:

  • Removing the requirement of having insurance or risk the consequence of suffering a fine
  • Ending Obamacare taxes on the wealthy
  • Changing how people get financial aide needed in order to purchase health insurance coverage on an individual level

Keeping in mind that this is still in the proposal stages, other items on the table for approval are:

  • Changing the way the Medicaid system is funded
  • Eliminate the rule that requires companies with 50 or more full time employees provide health coverage or pay a fine
  • Ending subsidies for out of pocket costs for low income Americans
  • Creating a new system of financial aid and penalties for those who allow coverage to lapse
  • Tax credits based on age – starting at $2,000 for those in their 20’s with a gradual increase to $4,000 for those aged 60 and over available to individuals who earn up to $75,000 and households up to $150,000
  • Insurers allowed to charger older citizens premiums up to 5 times the rate of younger people which is different from Obamacare’s 3 to 1 rate
  • Not giving states the authority to expand their Medicaid programs to all adults by 2020 after which date no newly eligible adults could sign up

The bill will still include:

  • Pre-existing conditions where insurers cannot deny coverage or charge higher rates to people with pre-existing conditions
  • The ability for adults under the age of 26 to get coverage from their parents plan
  • The 10 essential health benefits set up by The Affordable Care Act
  • The fact that insurers will be barred from setting maximum limits on benefits paid out

While there are many changes on the table, there are many items that will not change.  The republicans look to make changes to drive down costs while providing quality health insurance at more affordable prices. Some may challenge this by saying the plan will remove coverage from many Americans who couldn’t afford it previously.

Stay tuned as we continue to learn more about what actually ends up being approved.

If you have questions about your coverage or getting covered, contact me today!

I can be reached at: (813) 391-3448 or email me at

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Understanding the Different Health Insurance Options Available To You

When it comes time to select an insurance plan, which will you choose?  An HMO? PPO? EPO?  What do the acronyms mean and what are the differences?  This blog article will give you clear, concise understanding so you can make an informed decision when it comes time to choose or change your healthcare plan.

HMOs:  Health Maintenance Organization Plans

yocg-wednesday-10-26-16-canvaThis plan centers around a Primary Care Physician or a PCP.  Essentially, your PCP manages and coordinates your healthcare, referring you to specialists and hospitals within a designated network.  It is important to note that only those in-network services referred by your PCP will be covered by the plan.

PPOs:  Preferred Provider Organization Plans

PPO plans allow you and your family to receive care from any health care provider they choose within the insurance company’s network.  This list of providers can include specialists.  The major difference with a PPO is that a referral from your primary care physician or PCP is not required.  This type of plan is generally preferred by those individuals who tend to se a specialist on a regular basis.

EPOs:  Exclusive Provider Organization

This type of plan gives you access to all the providers and specialists within the EPO network.  EPO plans usually do not offer coverage outside of the network unless it is an emergency.  

POS:  Point of Service Plans:

This plan acts as a hybrid between the HMO and PPO.  In this type of plan, you usually select a primary care doctor for routine visits such as check ups as well as for specialist referrals.  The difference is, you are permitted to utilize providers outside of the network, but, you can expect your out-of-pocket expenses to be hight.  Additionally, you will be subject to copays and deductibles.  This type of plan works well for those who like the extra flexibility and who are willing to pay a little be more.

HDHP:  High Deductible Health Plan

yocg-thursday-10-20-16-canvaThis type of insurance plan has high deductibles which you must meet before the health insurance coverage actually goes into effect.  People attracted to this type of plan are those who want to save money on the monthly premiums.  These are also people who don’t intend on using their medical coverage as often as others.

This type of plan may also be used with a Health Savings Account or an HSA where the individual contributes to the account on a pre-tax basis allowing them to pay for healthcare expenses and deductibles.

Now that you are aware of the various plans available to you during open enrollment, you can make an informed decision.

Still have questions or concerns?  Contact me today!  I can be reached at (813) 391-3448 or Email me at

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2017 Open Enrollment…Are you READY?

It’s that time of year again!  Get ready to start thinking about open enrollment and what you need to do to make sure you and your family have health insurance coverage.

Here is what you need to know!


Open enrollment for 2016 is CLOSED.  BUT, If you still need coverage for the rest of 2016, you can get it but, only if you qualify. 

To qualify you need to meet one of these two criteria:

  • Special Enrollment Period due to a life event — like losing health coverage, getting married, or having a baby.
  • You qualify for Medicaid or the Children’s Health Insurance Program (CHIP).

You can apply for these programs any time throughout the year.

Let’s Brush Up On The Marketplace

About The Marketplace:

Who is it for?  The Marketplace is for individuals who do not have health coverage for the coming year.  That means, you do not have coverage through:

  • Your employment
  • Medicare
  • Medicaid
  • The Children’s Insurance Program (CHIP)
  • Another source providing qualifying coverage

How Much It Costs:

Health insurance through the Marketplace depends on your estimated income for the coverage year.  Did you know?  In 2017, roughly 8 out of 10 of uninsured people who are eligible for Marketplace coverage will qualify for financial assistance.*  The financial assistance  provided goes towards lowering the cost of the monthly premiums and in some cases is can also help with things like deductibles and copays.  Get an idea of what that could mean for you HERE.

Discover What The Marketplace Insurance Covers:

Essential health benefits – Every plan must include the following:

  • 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)
  • Pre-existing conditions, including pregnancy
  • Preventive care
  • Birth control coverage
  • Breastfeeding coverage

Pre-existing conditions, including pregnancy

Preventive care

Get a list of what that includes for:

What If You Do Not Get Health Insurance?

If you can afford health insurance and fail to obtain qualifying health coverage for the 2017 year, you may be fined.  This fine is referred to the “individual shared responsibility payment”. 

Fees are calculated in two different ways.  They are:

  • A percentage of your house hold income
  • Per person

You will be required to the highest rate calculated.

Fines for 2017 have not been released as of yet.

Do you have questions about your health insurance coverage for 2017?  I can help!  Contact me, Your Obamacare Guy!  I can be reached at:  (813) 391-3448 or email address:

* source:  http://www.HealthCare.gove/quickguide

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Subsidies, Deductibles & Premiums…OH MY!

Obamacare Guy Thursday 10 15 15Open Enrollment has OFFICIALLY begun!  As of November 1, 2015, you can get covered, change health plans or upgrade your current health plan without needing a change in life status.  AND…Right about now you may be in the midst of learning more than you ever needed to know about your income and how it relates to the Affordable Care Act’s (a.k.a. Obamacare) subsidies and deductibles.

This blog post is going to help you tremendously as we explore what a subsidies are, how you get them and how you can qualify for lower deductibles.

What Are Subsidies?

A subsidy is financial assistance you receive to help pay for health insurance coverage. A subsidy reduces your cost for insurance.

You may also qualify for reduced deductibles, and reduced co-pays.

Who Benefits From Subsidies?

Subsidies were designed to help low to moderate income Americans afford health insurance coverage.

To receive subsidies, you must have coverage on a plan in the Marketplace.

There are 3 types of subsides or cost assistance a person can receive.  They are;

  • Advance Premium Tax Credits which are used to lower premiums
  • Cost Sharing Reduction to help lower out-of-pocket costs
  • Medicaid and CHIP

How are Subsidies Calculated?

Your Obamacare Guy Tuesday 10 13 15 CANVASubsidies are calculated based on income and are available to people and their families who have an income level between 100-400% of the Federal Poverty Level.  Many people refer to this as the “FPL”.

NOTE:  The FPL or Federal Poverty Level adjusts every year to account for inflation.  This adjustment allows more citizens to quality for subsidies.

Specifically, the calculation used is something called MAGI or Modified Adjusted Gross Income.

MAGI is sum of the following:

Adjusted Gross Income +
Non-Taxable Social Security Benefits +
Tax-Exempt Interest +
Excluded Foreign Income
= MAGI (Modified Adjusted Gross Income)

Once you qualify for subsidies there are some points you should be aware of:

  • Subsidies are only valid on Plans purchased in the marketplace
  • Your marketplace health insurance plan cannot cost you more than 9.5% of your income AFTER tax credits are applied
  • The amount of cost assistance you can gain is based on the second lowest cost of the Silver Plan in your state’s marketplace

Who is NOT Eligible for Subsidies?

  • People reporting over 400% of the FPL will not be eligible for cost assistance
  • Those who have access to affordable, employer-based health insurance
  • People eligible for Medicare
  • Those who fall into the Medicaid gap

NOTE:  People who are making under 138% of the FPL are eligible for Medicaid.

When can I Apply for Subsidies?

Open enrollment is the PERFECT time to apply for subsidies and cost assistance.  If you don’t apply during open enrollment, you will need to wait until the following year’s open enrollment period or if you experience a life qualifying event.

Exploring Deductibles…

Obamacare Guy Tuesday 10 6 15 CANVAWhat is a deductible?

This is the amount of money you need to pay out-of-pocket for covered services before you insurance begins to pay.

This amount does NOT include:

  • Insurance Premiums
  • Costs that are NOT covered by your plan
  • Deductibles re-set every policy period

What happens after I meet my deductible?

Once you meet your deductible, your health insurance plan will pay it’s portion of your coinsurance.

Now that we know the basics of deductibles, discover how Obamacare has impacted them.

Here are some FAST FACTS pertaining to IN-NETWORK deductibles:

  • Obamacare mandates that major medical plans must meet specific cost sharing deductibles
  • Deductibles cannot be hight than out-of-pocket limits
  • Individual out-of-pocket limits are $6,600 (2015 figure)
  • Family out-of-pocket limits are $13,200 (2015 figure)

Deductibles – The More You Know…

Here are some quick tips you should be aware of when thinking about deductibles.

  • Deductibles start when your policy begins
  • Policy periods usually run from January 1st and ends December 31.  To ensure that you are taking full advantage of your policy period, make sure you are enrolled in a plan by December 15.
  • If you switch your plan mid-year, you may lose any deductibles already utilized
  • If switching plans during the year, try to use the same carrier to see if deductibles can be rolled over
  • Low deductible plans usually have higher premiums
  • High deductible plans tend to have lower premiums
  • Premiums do not count towards your deductible
  • Co-insurance usually does not start until deductibles are met
  • Co-pays usually go toward deductibles and out-of-pocket maximums

Obamacare Guy 9 30 15 CanvaThere is A LOT to consider during open enrollment and it can be confusing.  The best thing you can do for you and your family is to get sound advice from a professional.  As Your Obamacare Guy, it is my mission to help you get covered with the best plan and help you get the subsidies you need.

Call me today for help navigating your options when it comes to health insurance:  (813) 391-3448 or email me:

Glossary of Terms:

A fixed amount (for example, $15) you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service.

Your share of the costs of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service. You pay coinsurance after you’ve met your deductible. For example, if the health insurance plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your 20% coinsurance payment would be $20. The health insurance plan pays the rest.

Cost Sharing:
The share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, coinsurance, and copayments, or similar charges, but it doesn’t include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. Cost sharing in Medicaid and CHIP also includes premiums.

The amount you owe for covered health care services before your health insurance plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve paid $1,000 for covered services. Some plans pay for certain health care services before you’ve met your deductible.

A measure of income level issued annually by the Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits.

(The amounts below are 2015 numbers and used for calculating eligibility for Medicaid and the Children’s Health Insurance Program (CHIP). 2014 numbers are used to calculate eligibility for savings on private insurance plans for 2015.

•$11,770 for individuals
•$15,930 for a family of 2
•$20,090 for a family of 3
•$24,250 for a family of 4
•$28,410 for a family of 5
•$32,570 for a family of 6
•$36,730 for a family of 7
•$40,890 for a family of 8

The figure used to determine eligibility for lower costs in the Marketplace and for Medicaid and CHIP. Generally, modified adjusted gross income is your adjusted gross income plus any tax-exempt Social Security, interest, or foreign income you have.

The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.

Health coverage that’s obtained through financial assistance from programs to help people with low and middle incomes.

Glossary of terms were provided by:

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2016 Healthcare Open Enrollment FACTS & FIGURES!

2016 Healthcare Open Enrollment FACTS & FIGURES!

Obamacare Guy 9 29 15 Canva2016 Open Enrollment is fast approaching.  Hurry!  Grab your calendar!  It is time for you to mark some VERY important dates on your calendars.  If you miss these dates, it could mean the difference between paying healthcare penalty fees or not.

The following dates relating to obtaining health insurance coverage have been posted by

Late October:

Prices for health insurance plan rates purchased in the Health Insurance Marketplace will be published late October.

November 1, 2015:

This day marks the FIRST day of Open Enrollment.  Starting on November first you can obtain healthcare coverage through the Health Insurance Marketplace.  Coverage can start as early as January 1, 2016.

December 15, 2015:

This is the very last day to enroll or change plans and still have them be in effect for January 1, 2016.

January 1, 2016:

This is the first day of coverage for those who purchased plans and enrolled by December 15, 2015.

January 15, 2016:

There is still time to get covered!  This is the last day for you to obtain coverage or make changes to coverage and have them be in effect for February 2, 2016.

January 31, 2016:

This is the LAST day of open enrollment.  All enrollments and changes administered between January 16 and January 31, 2016 will be in effect on March 1, 2016.

I Recorded the Dates and Deadlines, Now What?

Obamacare 9 1 15 CANVA-2Now that you know WHEN you need to get coverage by, it is important for you to know how much coverage you need in order to qualify.

There is a specific list of plans or policies that are NOT considered as “minimum essential coverage”.  Those plans or services include:

  • Vision Care
  • Dental Care
  • Workers’ Compensation
  • Disease specific coverage
  • Plans offering discounts on medical services


Below is a list of plans or options you can use and qualify as “covered” by health insurance:

  • Purchase of any Marketplace health insurance plan
  • Individual health insurance plans you may already have in place
  • Health insurance offered by an employer
  • Retirement plans
  • COBRA Coverage
  • Medicare Part A
  • Medicare Part C
  • Children’s Health Insurance Program (CHIP)
  • Coverage on a parental plan if you are a dependent aged 26 years or younger
  • Self-funded healthcare plans for students offered by universities*
  • Peace Corps volunteers health coverage
  • Certain veterans plans offered by the Department of Veterans Affairs
  • Most TRICARE plans
  • Department of Defense Non-appropriated Fund programs
  • Refugee Medical Assistance
  • State high risk pools**

For a more detailed list, visit:

*These plans are specific to policy years that began on or before December 31, 2014.  Please check with the university for clarification and more information as to whether or not the plan is in line with “Minimum Essential Coverage” policies.

**Plans eligible are those that commenced on or before December 31, 2014.

What if I Don’t Get Health Insurance

Failure to Get Health Insurance Could Cost YOU!
What happens if you don’t enroll in a health insurance plan by January 31, 2016?  You may have to pay a fee for failing to get health insurance coverage.  The fee for not having health insurance in 2016 has INCREASED since 2015.

Here are some facts and figures you must consider before Open Enrollment Ends on January 31, 2016:

If you fail to get coverage in 2016 you could end up paying the higher of the two amounts listed below:

Dollar Amount #1:  2.5% of your annual household income

Dollar Amount #2:  $695 per person (children under 18 are calculated at $347.50/child)

There are some other timing circumstances to take into consideration when talking about failure to have health insurance coverage.  See the Q & A segment below:

Q: What if I was uncovered for a portion of the year?

A: You would pay 1/12 of the annual penalty for each month you were not insured.

NOTE:  if you did not carry insurance for 2 months or less, you would not have to make a payment

Q: What if I was unemployed?

A: Penalty fees for not carrying insurance is based on your household income.  If it is determined that healthcare insurance was unaffordable based on your income, you could possibly qualify for an exemption.

Other Important Questions You May Have…

How will I pay?

This payment will take place when you file your taxes.  More specifically, it will be included on the tax return for the year you did not have health care insurance coverage.  For example, if you did not have health insurance during 2015, you would pay the penalty fee when you file your taxes on or before April 15, 2016.

What will happen if I fail to pay the penalty fee for not having healthcare insurance?

The Internal Revenue Service will withhold the amount you owe from any tax refunds you may get in the future.  You will NOT experience any:

  • Liens
  • Levies
  • Criminal penalties

Now that you know, what is considered as minimal essential healthcare coverage, who needs it and by when, it’s time to get you covered!  As “Your Obamacare Guy”, I am dedicated to help you get the best and most affordable health insurance plan for both you and your family.  If you are confused, have questions or need help navigating through the Marketplace, call me!  You can reach me at:  (813) 391-3448 or email me:


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Obamacare, Preventive Care and YOU!

Obamacare, Preventive Care and YOU!

Obamacare Guy 08 26 15 CANVADid you know?  Obamacare (a.k.a. The Affordable Care Act) is focused on your overall health and well-being.  Many people are not aware that the Obamacare plan includes preventive care with NO out-of-pocket costs on most of the plans.

As a matter of fact, instead of focusing on treatment and cures, Obamacare’s FREE preventive services focus on overall well-being by:

  • Focusing on wellness
  • Promoting early detection
  • Practicing Prevention

Did you know?  Major Medical Plans purchased after 2014 include the following without copays and co-insurance when used within network to avoid cost sharing:

  • 1 wellness visit
  • 14 FREE preventive services

Defining Preventive Care:

Preventive care takes a look at who you are as “healthy you”.  A homeostatic or baseline of how you present when you are healthy and symptom free.  Preventive care’s aim is to provide routine screenings to help detect the early onset of health issues.  The idea is to to identify health issues early and resolve them before they become larger, more serious health concerns.

Preventive care includes such things as: immunizations, shots, screenings, tests and 1 FREE annual wellness visit.

Thursday 8 13 14 Your Obamacare guy CanvaWho Is Eligible for Preventive Care?

The Affordable Care Act or “Obamacare” requires most health plans to cover certain services at no out-of-pocket costs.

Who Gets What…

Below is a list of the number of preventive care services that are allotted in each group listed

  • Adults Receive 15
  • Women Receive 22
  • Children Receive 26

The chart below displays all the preventive services available by category.

If your current plan does not provide these preventive care benefits, contact me immediately for help at (813) 391-3448.

Your Obamacare Guy Preventive Care Chart

For more information or to see if you qualify for cost assistance on a new marketplace plan or to learn more about ObamaCare’s new benefits, rights and protections, please contact Your Obamacare Guy; Dave Taylor at:  (813) 391-3448.

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What is Obamacare?

What is ObamaCare?

When people talk about health care and health insurance, the phrase “Obamacare” is used A LOT!  It is used so often, that we may not fully understand all that Obamacare offers.

Facebook Profile PicturesGREAT news!  My expertise is Obamacare and as YOUR Obamacare Guy, I am expertly positioned to help navigate and guide you through our Nation’s health care program, The Patient Protection and Affordable Care Act.

Let’s get down to basics…

What exactly is Obamacare?

Obamacare is a term many have adopted as the unofficial term used to easily reference and identify the The Patient Protection and Affordable Care Act which was signed into law on March 23, 2010 by President Barack Obama.

What Exactly Is The Affordable Care Act?

medical-563427_640In the simplest of terms, it is a law designed to reform the healthcare and health insurance system in the U.S.A.  The main goal of the law was to provide more Americans with access to affordable health insurance.

With this new law came many new healthcare benefits, rights and protections.  These benefits include:

  • Health Insurance Marketplace (also referred to as Exchanges) which allows people to compare healthcare plans that fulfill the minimum essential coverage requirement
  • Cost assistance available to individuals, families and small businesses
  • Increased Medicaid eligibility
  • Full-time employee coverage must be offered by large employees
  • Annual or lifetime limits on healthcare are lifted
  • Cannot be denied coverage for any reason
  • You cannot be charged more due to health status or gender
  • Insurance companies are not permitted to drop you when you are sick or for making an erroneous entry on your application for coverage.
  • Insurance may not deny you for a pre-existing condition or conditions
  • The 80/20 rule is designed to protect you against unfair premium increases
  • You have the right to appeal any health insurance company decision
  • You have the opportunity and ability to gain access to easy-to-comprehend explanation of coverage and benefits
  • Children have the ability to stay on their parents insurance plan until the age of 26
  • New and FREE women’s health preventative treatments and screenings
  • OB-GYN services no longer need referrals

Fact:  Before The Affordable Care Act became law there we over 44 million uninsured Americans!

question-mark-452707_640Answers to the Questions You Were Too Embarrassed to Ask!

Let’s face it, if you are not involved in “Obamacare” on a daily basis, it can seem VERY overwhelming!  That’s why I am here.  As your Obamacare Guy, I want to answer your questions and help you understand The Affordable Care Act as well as help you get the BEST coverage possible!

Let’s JUMP Right Into it!

Below are a list of questions I receive on a regular basis.  What I have done, is broken them down into easy to understand answers.  Some of the questions are more definitions of terms used in Obamacare discussions.  Simply understanding the terms will answer a bunch of questions!

What are health insurance marketplaces and exchanges?
Marketplaces and exchanges are used interchangeably.  Basically, it is the only shopping center for health insurance.  These marketplaces are available to people during open enrollment periods that run between November 1 – January 31.  During this period of time, people can search for health plans and compare choices, making a selection at fits your needs.  It will also help you determine if you are eligible for a subsidy.

What is a subsidy?
A subsidy is a tax credit that helps you pay for your insurance plan.  Put simply, its the money the govt pays the insurance company for you.  If your plan costs $300 and you have a $250 subsidy, you only pay $50.

What types of insurance are on the exchange?
There are 5 different types of plans you can select from.  Below is a simple list:

  1. Platinum – Highest monthly costs
  2. Gold – Higher monthly costs
  3. Silver – Best value for the money and the only one that gives you Subsidies, Reduced deductibles, and Reduced maximum out of pocket limits.
     – Key Point…The Silver plan’s benefits change based on income.  The Silver plan can give you most of the benefits of the Platinum plan if you qualify and its done right.
  4. Bronze – Offers less coverage and slightly less cost
  5. Catastrophic – Covers basic care in case of an emergency available to those ages 30 and under or those who are unable to find insurance that costs less than 8% of their income

If I am buying my own insurance, does it have to be purchased on the exchange?
No, it is up to you where you purchase your plan.  Keep in mind, subsidies are not available if you purchase a plan privately and not through the exchange.

Those are just a sampling of the questions I receive.  Stay tuned to my blog as I will be exploring these questions and many more and in more detail!

I hope this article was helpful to you and gave you some base knowledge on Obamacare.  As Your Obamacare Guy, I look forward to helping you make sense of Obamacare and assist you in selecting the right coverage for you.

About Dave Taylor, MBA, RFC
Dave Taylor is an expert in Obamacare and has helped many hundreds of clients get coverage, subsidies and reduced deductibles.

Dave can be reached in is office at (813) 574-1222 or cell (813) 391-3448.  Visit Dave’s website: or email him at