Common questions, straight answers.
If you have a question that is not answered here, call us or start a conversation with our AI concierge.
General
Working with Yumi Health
Cost, licensing, carriers, privacy, and how our process works.
Does working with Yumi Health cost me anything?+
No. Carriers pay Yumi a commission when you enroll in a plan. This commission is built into the plan premium — it does not add to your cost. The premium you pay is identical whether you enroll through us or directly with the carrier. We are also prohibited by law from charging you a fee for Medicare advice.
Are Yumi Health advisors licensed?+
Yes. Yumi Health Group LLC is licensed by the New Jersey Department of Banking and Insurance (DOBI). Every advisor holds an active NJ health insurance producer license and completes annual carrier certification and CMS training.
Which carriers does Yumi work with?+
We partner with 20+ carriers including Horizon BCBSNJ, Aetna, UnitedHealthcare, Humana, Cigna, WellCare, AmeriHealth NJ, Clover, Oscar, Ambetter, Mutual of Omaha, and Anthem, among others. Because we are independent, we recommend based on fit — not on which carrier pays us more.
Do you only serve New Jersey?+
Currently yes. We are licensed in New Jersey and serve all 21 counties. We are actively licensing in additional states and will update this page as new markets open.
Will I feel pressured to enroll?+
No. We do not use urgency tactics or call scripts designed to rush decisions. Take the time you need. Some clients enroll in one conversation; others research for several weeks. Both are fine.
What is TrueCost™?+
TrueCost™ is our proprietary cost-projection engine. It goes beyond the monthly premium to model your expected deductible spend, drug costs by formulary tier, specialist copays, and estimated annual out-of-pocket maximum — based on your conditions, medications, and doctors. It lets you compare plans on equal footing, not just by their headline premium.
How do I reach a licensed advisor?+
Call (201) 633-7713 (Mon–Sun 8 AM – 9 PM), email contact@yumihealthgroup.com, or start online at yumihealthgroup.com/guide. The AI concierge can give you plan estimates immediately; a licensed advisor picks up any conversation that needs a human.
Is my personal information kept private?+
Yes. We collect only the information needed to compare and enroll in coverage. We do not sell your data to third parties or share it outside of the enrollment process. Our systems are HIPAA-compliant and our data is hosted on Microsoft Azure infrastructure in the United States.
What is Yumi Health?+
Yumi Health is a licensed health insurance advisory service based in Hackensack, NJ. We connect individuals and families with licensed insurance agents who help you compare and enroll in Medicare, ACA marketplace, and supplemental insurance plans. We are an independent brokerage compensated by carriers, so our only job is finding the plan that fits you best.
How do I get started?+
The fastest way is to start our AI concierge at yumihealthgroup.com/guide — you'll get plan estimates immediately. You can also call us at (201) 633-7713 to speak with a licensed NJ advisor directly. Either way there is no obligation.
Can I switch plans if I'm already enrolled somewhere?+
In many cases, yes. During open enrollment periods you can switch plans freely. Outside of open enrollment, you may qualify for a Special Enrollment Period due to life events like moving, getting married, losing coverage, or turning 65. A Yumi Health advisor can help you determine your eligibility.
Medicare
Medicare questions
Enrollment windows, plan types, and NJ-specific rules.
What is the Annual Enrollment Period (AEP)?+
AEP runs October 15 – December 7 every year. During AEP you can switch Medicare Advantage or Part D drug plans; changes take effect January 1. If you miss AEP, your next opportunity is generally the Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31), which allows one plan change.
What is the ACA Open Enrollment Period (OEP)?+
For NJ residents on GetCoveredNJ, Open Enrollment is November 1 – January 31. If you miss OEP, you need a qualifying life event (job loss, marriage, birth of a child, move) to trigger a Special Enrollment Period. Year-round enrollment is NOT available without a qualifying event.
What is a Scope of Appointment (SOA)?+
The SOA records the topics you agreed to discuss with a Medicare advisor. Both you and your advisor sign it. It is not an enrollment form — it simply confirms the agenda. There's no waiting period: sign it and your advisor can review plans with you the same visit.
What is the difference between Medicare Advantage and Medigap (Medicare Supplement)?+
Medicare Advantage (Part C) replaces Original Medicare and bundles hospital, medical, and often drug coverage into one network-based plan — often with a $0 premium. Medigap supplements Original Medicare and pays your share of costs (deductibles, coinsurance) when you see any Medicare-accepting provider in the US. Medigap offers more flexibility and predictable costs but typically has a higher monthly premium. In New Jersey, community rating applies to Medigap — meaning carriers cannot charge more based on your age or health history.
Can I switch from Medicare Advantage back to Original Medicare?+
Yes. You can return to Original Medicare during AEP (Oct 15 – Dec 7) or the MA OEP (Jan 1 – Mar 31). However, if you want to add a Medigap plan after you have had Advantage, you may face medical underwriting in most states. New Jersey has some additional protections — ask your advisor.
How do ACA subsidies work in New Jersey?+
Federal premium tax credits lower your monthly premium if your household income is between 100% and 400% of the federal poverty level (FPL). The enhanced credits enacted under the American Rescue Plan temporarily expanded eligibility above 400% FPL as well. NJ also offers state subsidies (NJ Health Plan Savings) that stack on top of the federal credit for households up to 600% FPL. Use our subsidy checker at /v2/aca-eligibility to estimate your credit.
What is a Special Enrollment Period (SEP) for ACA?+
An SEP lets you enroll outside OEP if you experience a qualifying life event: losing job-based coverage, getting married or divorced, having a baby, moving to a new county or state, gaining citizenship, or certain other events. You generally have 60 days from the event to enroll.
Do I need a referral to see a specialist under Medicare Advantage?+
It depends on the plan type. HMO-based Advantage plans typically require a referral from your primary care physician. PPO-based Advantage plans usually do not require a referral but may charge more for out-of-network care. PFFS plans have their own rules. Your advisor can filter plans by type so you understand what to expect.
ACA / Marketplace
ACA & marketplace questions
NJ subsidies, GetCoveredNJ, metal tiers, and special enrollment.
What is the ACA marketplace?+
The Affordable Care Act (ACA) marketplace — also known as the Health Insurance Marketplace or exchange — is where individuals and families shop for and purchase health insurance plans. Plans are standardized into metal tiers (Bronze, Silver, Gold, Platinum), making it easier to compare coverage and costs. New Jersey's marketplace is GetCoveredNJ.
Do I qualify for ACA subsidies?+
You may qualify for premium tax credits or cost-sharing reductions based on your household income and size. Many people are surprised to learn they qualify for significant financial help. NJ also offers additional state savings that stack on top of the federal credit for households up to 600% of the federal poverty level. A Yumi Health advisor can estimate your subsidy amount in minutes.
When can I enroll in an ACA marketplace plan?+
The annual Open Enrollment Period runs November 1 through January 31 for NJ residents on GetCoveredNJ. Outside this window, you may qualify for a Special Enrollment Period if you experience a qualifying life event such as losing employer coverage, getting married, having a baby, or moving to a new area. You generally have 60 days from the qualifying event to enroll.
What do ACA plans cover?+
All ACA-compliant plans must cover 10 Essential Health Benefits, including hospitalization, prescription drugs, maternity and newborn care, mental health services, preventive care, and more. Preventive services such as annual check-ups and vaccinations are covered at no cost to you on any metal tier.
Working with us
Advice, matching & service
How agent matching works, what to expect, and how to reach us.
How does the agent-matching process work?+
When you contact us, we gather some basic information about your coverage needs, location, and preferences. We then match you with a licensed advisor who specializes in the relevant coverage area. For Medicare clients, this includes obtaining a Scope of Appointment (SOA) before any sales discussion — a CMS requirement we follow for every appointment.
Will I be pressured to buy a plan?+
Never. Our advisors are here to educate and advise, not to pressure you. You are always free to take your time, ask questions, and make the decision that feels right for you. There is absolutely no obligation to enroll.
Can I work with the same advisor year after year?+
Yes. Many clients develop long-term relationships with their advisor. Your advisor can help you review your coverage annually, navigate plan changes, and ensure you always have the best options available. We proactively reach out every fall before the Annual Enrollment Period.
What if I have a complaint or concern about my experience?+
Your satisfaction is our priority. If you have any concerns about your experience, please contact us at contact@yumihealthgroup.com or call (201) 633-7713. We take all feedback seriously and will work to resolve any issues promptly.
Still have questions?
Call (201) 633-7713 or start with our AI concierge — licensed advisors are always available.