Frequently Asked Questions
There are no stupid questions in Healthcare.
I’ve compiled this list of questions from clients to help you
better understand your options.
How are health insurance prices calculated?
The Public Marketplace, or the Affordable Care Act(ACA)/Obamacare plans are based on your estimated household income, number of household members, your age and your gender. 25 Million Americans qualify for a Tax Credit to help reduce the cost of their health insurance. Contrary to popular belief, you cannot make too much money to qualify for insurance through the Affordable Care Act; and if you make more money, you do not pay more. Insurance has a set rate, and your monthly premium can only be reduced by your income, not increased.
Private plans are based on health, age and gender. Income does not play a factor. Private plans are typically better for healthy individuals with minor pre-existing conditions. If you can qualify for a medically underwritten private plan, you will have lower monthly payments, lower deductibles, lower maximum out of pocket costs, and you will have access to the largest network of doctors.
Is there an Open Enrollment for Private insurance?
Unlike the ACA/Obamacare which has a specific Open Enrollment period from November 1st – January 15th, Private insurance is available all year long. You can sign up at anytime and your policy can start the same day in most cases.
The ACA/Obamacare plans can only start on the 1st of the month.
Does insurance have year long contracts?
Private insurance does not have a required length of time that you have to keep it. You can cancel at anytime without any penalties. In some states, private insurance has a 6 month term, so be sure to ask your agent if you are in one of those states.
The ACA/Obamacare does not have a required length of time either, and you can cancel your policy at anytime.
Employer plans may or may not have a year long contract. In most cases, you are not allowed to leave your employer plan to switch to a private plan, unless you have a qualifying event. You need to check with your HR Department to determine if you can cancel your plan before the end of the contract.
Is there a fee for your services?
There is no fee to utilize my expertise in your decision. If you were to choose a plan that I assist you with, then I am paid by the insurance company based on how long you keep the policy. That’s why it’s so important to find the best plan for you and your family. My goals is to have you become a lifetime client (65 years old).
What insurance plans/carriers do you offer?
I offer Medical, Dental, Vision, Life, Accident, Supplemental, Critical Illness, and Short Term Disability. My goals is to create the perfect plan to meet your needs.
As far as carriers, I work with all of the major carriers, so as not to limit your options. Each state is different, so being licensed in 31 states, it is important to work with every carrier.
I am licensed in AL, AR, CO, DE, FL, GA, IL, IN, IA, KS, KY, LA, MD, MI, MS, MO, MT, NC, NE, NV, OH, OK, SC, TN, TX, UT, VA, WI, WV, WY, SD.
Do you have Nationwide or International Plans?
If you choose a plan from the ACA/Obamacare marker, your plan is limited to State Coverage, sometimes even limiting you to the county in which you live.
Now, Private Plans are PPO plans and will cover you Nationwide. They will even provide coverage on and off the job.
There are special International Plans but the Private and Marketplace plans will not cover you when you travel out of the country.
What is the difference, in layman’s terms, between the ACA, Employer and Private insurance plans?
The ACA is considered major medical coverage that provides you coverage for any pre-existing condition. However, it does not mean that they will cover everything. Many of the plans limit coverage and do not cover a large number of expensive medications. The rates for the ACA are the most expensive on the market, unless you qualify for a government subsidy, or Tax Credit, to help you pay your monthly premiums. If you do not qualify, the full price option and high deductible make it unaffordable to most people.
The next is Employer plans. Employer plans are often very cost effective for the employee, however, when you add family members you will pay full price. Depending on the size of the Group, these rates can be more expensive than the ACA plans. I will often recommend keeping the employee on the employer plan, and putting the family on a Private Plan to be more cost effective.
Private plans are almost always based on health, so you have to qualify based on yours. Each family member is medically underwritten to determine qualification. If you qualify, you will receive the best rates, with low deductibles and low maximum of out pockets. Please note that not all private insurance is created equal. Always make sure you receive a State License and Brochure before you purchase any plan.
Copyright (c) 2022 – 2023