Frequently Asked Questions

Most people are not aware that health insurance agents do not charge for their service(s). 

Insurance agents are paid by the health insurance carriers in the form of a commission.  The agent's commission is based on the type of policy they sell.

Health insurance is an important tool in managing our health care needs. It protects us from high, unexpected medical expenses and gives us access to a broad range of care providers. Health insurance also helps to keep us healthy by providing preventive services, such as screenings and vaccines, at little or no cost. In addition, health insurance can provide peace of mind in knowing that we are prepared for the unexpected. For these reasons and more, health insurance is an essential part of maintaining our health and wellbeing.

The open enrollment period for health insurance coverage under the Affordable Care Act (ACA), also known as Obamacare, begins on November 1 and ends on January 15. 

This period is when people who do not have health insurance can sign up for a plan through the health insurance marketplace. Those who are already enrolled in a plan can also use this time to shop around for a new plan or to make changes to their existing coverage. 

The ACA requires most people to have health insurance, and the open enrollment period is the only time when people can sign up for coverage unless they experience a qualifying life event, such as losing job-based coverage or getting married. For those who do not have health insurance or who want to explore their options for coverage, the open enrollment period is an important time to do so.

Special Enrollment is a period of time when individuals and families can sign up for health insurance outside of the Open Enrollment period. This period is typically reserved for those who have recently experienced a qualifying life event, such as losing other health coverage, getting married, or having a baby. 

Special Enrollment generally lasts for 60 days from the date of the qualifying event. However, state and federal rules can vary, so it's important to check with your insurance company or marketplace to see if you're eligible and to find out how long you have to enroll. 

Individuals who miss the Open Enrollment deadline may still be able to qualify for a Special Enrollment period if they experience a qualifying life event. However, it's important to note that you won't be able to enroll in coverage until after the event has occurred. 

For example, if you experience a job loss on February 15th, you won't be able to enroll in coverage until after that date. If you wait until March 1st to start shopping for coverage, your new policy wouldn't take effect until April 1st. So, if you need health insurance right away, it's important to act quickly and not wait until the last minute. 

You can learn more about Special Enrollment periods and how they work by visiting healthcare.gov or contacting your insurance company or marketplace directly.

A health insurance premium is the amount of money that a person or family pays to a health insurance company each month to maintain their coverage. The premium is typically paid in addition to any deductibles, copayments, or coinsurance that the policyholder may owe when they receive medical care. Premiums can vary widely based upon the type of coverage that is being purchased, as well as the age and health of the individuals covered. 

In some cases, employers may cover a portion of their employees' premiums; in others, employees may be responsible for the entire amount themselves. For those who are self-employed or not working, there may be options for subsidies or premium assistance programs to help offset the cost of coverage. Ultimately, the amount of a health insurance premium is just one factor to consider when choosing a policy.

A health insurance deductible is the amount of money that you are required to pay out-of-pocket before your health insurance company will begin to pay for your medical expenses. The deductible is usually a set dollar amount, and it may be different for each type of service that you receive. 

For example, you may have a $500 deductible for hospital services and a $100 deductible for doctor's office visits. In some cases, the deductible must be paid before you receive any coverage at all; in other cases, you may be able to get partial coverage even if you have not yet met your deductible. 

In general, the higher your deductible is, the lower your monthly premium will be. Therefore, it is important to choose a deductible that you feel comfortable with in case you need to use your health insurance.

Co-insurance is a type of cost-sharing between an insurer and an insured. Typically, the insurer will pay a fixed percentage of the covered costs while the insured pays the remaining costs. 

For example, if an insurer has an 80/20 co-insurance with a $1000 deductible, the insurer would pay 80% of the covered costs after the deductible has been met, up to a maximum out-of-pocket limit. The insured would be responsible for paying the other 20% of the covered costs as well as the entire deductible. In this scenario, the insurer would pay $800 while the insured would pay $200. 

An out-of-pocket maximum is the most you would have to pay in a year for your share of covered expenses. It does not include your premium. It's important to know that your coverage may have more than one out-of-pocket maximum. 

For example, you may have an overall out-of-pocket maximum for all deductibles, copayments, and coinsurance. You also may have a separate out-of-pocket maximum for prescription drugs. The out-of-pocket maximums may be different for in-network and out-of-network services. 

Once you reach your out-of-pocket maximum, your health plan pays 100% of the covered allowed amounts for the rest of the plan year. 

Example: Let's say you have an overall out-of-pocket maximum of $3,000 per year and a $250 deductible. During the year, you have $1,500 in doctor visit copayments, $800 in prescriptions, and $450 in other covered services such as x-rays and laboratory tests. Your total out-of-pocket costs would be $2,950 ($250 + $1,500 + $800 + $450), so you've met your overall out-of-pocket maximum for the year. In this case, your health plan would pay 100% of any further covered allowed charges for the rest of the plan year. 

Be aware that some types of services are not counted towards meeting your out-of-pocket maximums. These include most preventive care services, some office visits, some vaccines, and sometimes dental and vision care for children.

When it comes to choosing a health insurance plan, there are a lot of options to consider. Two of the most common types of plans are HMOs and PPOs. Both have their own set of advantages and disadvantages, so it's important to understand the difference between the two before making a decision.

An HMO, or Health Maintenance Organization, is a type of plan that typically requires you to use in-network providers. This means that you'll likely have lower out-of-pocket costs. 

A PPO, or Preferred Provider Organization, is another type of health insurance plan. With a PPO, you typically have more flexibility when it comes to choosing providers. You can still save money by using in-network providers, but you don't usually have to pay as much if you need to see an out-of-network provider. However, PPOs typically have higher premiums than HMOs.

When it comes to choosing between an HMO and a PPO, it's important to consider your individual needs and preferences. If you prefer more flexibility when it comes to choosing providers, then a PPO might be the better option for you. However, if you're looking for lower premiums and out-of-pocket costs, then an HMO could be the way to go.