Frequently Asked Questions About Health Insurance

A licensed agent can guide you through the enrollment process from start to finish. They can do the homework for you by comparing providers and health insurance plans. They also act on your behalf, not the insurance company’s. Agents can build a trusting relationship with you over time and scale your insurance plan as your family grows. You also receive personalized service along the way.

Some of the most common advantages of private health insurance over ACA Health Insurance include lower premiums, flexible PPO plans, additional optional features, and plans that target your medical needs.

The cost of health insurance depends on several factors. Costs vary based on your plan type, whether you have insurance through an employer or private insurer, what state you live in, and how much of the insurance you cover. Additionally, if you purchase your coverage through the healthcare exchange, you may qualify for government subsidies based on your household income.

Your deductible is your upfront financial responsibility before the insurance starts paying. Some services are deductible waved, check your plan summary for details.

Co-insurance is the percentage split between you and the insurance company after you meet your deductible. You may be responsible for up to 50% of the bill, after meeting the deductible but only up to the maximum out of pocket.

Your maximum out of pocket is the most you will pay for covered services in a calendar year.

A co-pay is a set amount that you pay for service. Often insurance plans will have co-pays for a doctor’s office visit, out- patient mental health visit, etc.

The premium is the amount you pay to the insurance carrier for your health insurance plan.

PPO stands for preferred provider organization. With a PPO you can see in network medical professionals, or out of network medical professionals. Your benefits are much richer when using in network medical professionals.

HMO stands for health maintenance organization. You must choose a primary care physician who manages your care and refers you to in network specialists if necessary.

EPO stands for Exclusive Provider Network. You may see any contracted physicians, but the plan does not cover non contracted medical professionals or facilities.

EOB – Explanation of benefits. Provided by the insurance company to show how services billed were covered by your insurance. How much the medical provider billed your insurance company, how much the negotiated rates lowered the bill, how much was applied to your deductible, and what your financial responsibility is.

SBC – Summary of Benefits and Coverage, outlines how your coverage works. A requirement since health care reform, designed to help understand and compare coverage options from each carrier in a standardized format.

HSA stands for health savings account. You must have an HSA compatible health insurance plan in order to contribute funds to a health savings account. A health savings account allows you to use pre-tax dollars to help pay for qualified medical and dental expenses.

Open enrollment is the period when you can make changes to your benefits or chose a new health insurance plan. The open enrollment period for 2021 plans is November 1 through December 15.