For patients
Coverage help, close to home.
If your prescription suddenly rejects or your plan has changed, you may be able to get new coverage outside Open Enrollment. Clear Benefits works with independent pharmacies so you can find help with ACA Marketplace plans, and soon Medicare, while you stay with the pharmacy you trust.
Did your coverage change?
A life change can open a Special Enrollment Period.
A Qualifying Life Event is a significant life change recognized under the Affordable Care Act. It lets you enroll in or change health coverage outside the annual Open Enrollment Period. Most Special Enrollment Periods last 60 days from the date of the event, so it pays to act early.
Common Qualifying Life Events
- Losing Medicaid, CHIP or employer insurance
- Aging off a parent’s employer plan
- Marriage or divorce
- Birth or adoption of a child
- A permanent move to a new state or area
- A substantial change in household income
During a Special Enrollment Period, eligible people may enroll in or switch Marketplace plans, add or remove dependents, update household or income information and access premium tax credits if eligible.
ACA Marketplace plans
Clear, unbiased guidance with Honesty.ai.
Participating pharmacies can point you to Honesty.ai, Entratus’ AI-powered system that helps you explore and enroll in ACA Marketplace plans. Recommendations are based on your health, your budget and your pharmacy preferences.
Personalized health plans
Tailored ACA recommendations based on individual health, budget and pharmacy preferences.
Transparent guidance
Honest, AI-driven conversations that help patients understand their health plan options without confusion.
Seamless navigation
A guided experience that simplifies plan exploration, so patients feel confident in their coverage decisions.
Hassle-free enrollment
A smooth, step-by-step process that makes signing up for ACA plans easy and stress-free.
Medicare
Medicare and Medicare Advantage, made simpler.
Clear Benefits is dedicated to simplifying the complexities of Medicare and Medicare Advantage plans for both independent pharmacies and patients. Medicare options in Honesty.ai are coming soon.
Have a Medicare question now? Ask your local independent pharmacy, or call Clear Benefits at (833) 627-4414.
Why your pharmacy
Your pharmacist is often the first to see a coverage problem.
Real-time answers at the counter
Prescription claims process in real time, so your pharmacy can tell you right away when coverage has changed.
Guidance to the right resources
Pharmacy staff can explain what changed in general terms and point you to trusted enrollment resources.
Stay with the pharmacy you trust
Coverage help through the Affinity Marketing Program keeps you connected to your local pharmacy.
Paying cash for a prescription? PPOk’s sister brand Fill Local Rx offers a pharmacy-friendly prescription discount program.
Patient questions
Coverage questions, answered
General information only. For decisions about a specific plan, talk with a licensed professional.
What is a Qualifying Life Event?
A Qualifying Life Event is a significant life change recognized under the Affordable Care Act that lets you enroll in or change health coverage outside the annual Open Enrollment Period. Examples include losing Medicaid or employer insurance, marriage, divorce, birth or adoption, a permanent move, or a substantial change in income.
How long does a Special Enrollment Period last?
Most Special Enrollment Periods last 60 days from the date of the life event. If the window is missed, in most cases you must wait until the next Open Enrollment Period.
Does losing Medicaid count as a Qualifying Life Event?
Yes. Loss of Medicaid or CHIP coverage typically qualifies for a Special Enrollment Period.
Are ACA subsidies still available in 2026?
Yes. ACA premium tax credits are still available, but the enhanced subsidies expired at the end of 2025 and the rules reverted to pre-2021 levels. Many people now qualify for smaller subsidies, and some households no longer qualify at all.
Can my pharmacist pick a plan for me?
Pharmacy staff should not recommend specific plans or insurers unless they are properly licensed. Your pharmacy can explain coverage changes and point you to trusted enrollment resources such as Honesty.ai, which gives personalized recommendations based on your health, budget and pharmacy preferences.
Not sure where to start?
Call us or send a message. Please do not include health information in your message.