Here are some common questions people ask that would work great on your website FAQ page.
A premium is the monthly amount you pay to keep your health insurance policy active.
Note: Even if you do not use your insurance during the month, the premium must still be paid in order to maintain coverage.
Your deductible is the amount you must pay out-of-pocket for covered medical services before your insurance begins sharing the cost.
Example: If your deductible is $3,000, you would pay the first $3,000 of covered medical expenses before your insurance starts contributing toward the cost.
A copayment (copay) is a fixed amount you pay for certain services, such as doctor visits or prescriptions.
Examples may include:
Copayments may apply even before the deductible is met, depending on the plan.
Coinsurance is the percentage of medical costs you pay after your deductible has been met. Instead of paying a flat fee like a copay, coinsurance means you and the insurance company split the cost of a service by a percentage.
Example: Let’s say your plan has:
After you have paid your $2,000 deductible, the insurance company starts sharing the cost.
If you have a medical bill of $1,000
Your maximum out-of-pocket limit is the most you will have to pay for covered healthcare services during a plan year.
Once you reach this limit, your insurance plan will typically pay 100% of covered medical expenses for the rest of the year.
This amount includes:
The plan may also have a family maximum out-of-pocket, which is usually about double the individual limit.
Example: Coverage Type: Maximum Out-of-Pocket
If the combined medical expenses of everyone on the plan reach the family maximum, the insurance company will then pay 100% of covered services for everyone on the plan for the rest of the year.
A subsidy is financial help from the government that lowers the monthly cost of health insurance through the marketplace. The amount you qualify for is based on your household income, family size, age(s), and ZIP code.
Example: If a plan costs $600 per month and you qualify for a $450 subsidy, you would only pay $150 per month for the plan.
Keeping your doctor depends on the insurance company’s provider network. Each Marketplace plan has its own network of doctors, hospitals, and specialists. If your doctor is in-network, you can continue seeing them at the plan’s covered rate. If they are out-of-network, the plan may not cover the visit, or it may cost more.
Most people enroll during open enrollment, which usually runs from November 1st through December 15th. However, certain life events may qualify you for a Special Enrollment Period.
To check plans and possible subsidies, we usually need:
Here at Crown Point Health Advisors, there is no cost for you to work with a licensed health insurance agent. We help you compare plans, understand your options, and enroll in coverage.
Marketplace plans are health insurance plans available through the Affordable Care Act (ACA). These plans are offered through the federal or state health insurance marketplace.
Many individuals and families qualify for premium tax credits (subsidies) based on their household income, which can significantly reduce the monthly premium.
Marketplace plans must include the ACA’s essential health benefits, including:
Marketplace plans are typically available during Open Enrollment, although some people may qualify for a Special Enrollment Period if they experience a life event such as losing coverage, moving, getting married, or having a baby.
Private health insurance plans are offered outside the government marketplace through private insurance carriers.
These plans may offer:
Private plans can sometimes offer more flexibility depending on your healthcare needs.
An independent agent can help compare both marketplace and private options to determine which plan may be the best fit for your situation.
Private health insurance plans can be a good option for some individuals and families, especially those looking for broader provider networks or different coverage options. However, eligibility for these plans may depend on your health history.
Unlike Marketplace (ACA) plans, many private health insurance plans may require medical underwriting, meaning the insurance company reviews your health history before approving coverage.
Because of this, some individuals with certain pre-existing or ongoing health conditions may not qualify for private plans.
If a private plan is not an option, Marketplace plans are available and cannot deny coverage due to pre-existing conditions.
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