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Health Insurance Frequently Asked Questions

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If you have questions about health insurance, we offer answers to some of the most common questions we hear from our clients.

Which health insurance plan is the best?

No health insurance plan is the best for everyone. Each individual and family has a unique situation with regard to income from work, the number of children, and medical conditions. Choosing the best health insurance requires a look at what is affordable, and the plans offered by the various health insurance providers in your area.

What changed when the ACA went into effect?

Several changes were made to how health insurance companies operated when the ACA (Affordable Care Act) went into effect. One of the most significant was that the health insurance companies could no longer deny coverage due to a pre-existing condition. The insurance companies were also required to offer a comprehensive set of benefits, including preventative care and rehabilitation, among others. Another change that made a real difference for families was that parents could keep their children on their health insurance until they reached age 26.

Can I combine my work health insurance with Medicare?

If you are still working and have reached age 65, you can sign up for Medicare Part A (hospital insurance), Part B (medical care), and D (prescription drug plan), or a “Medigap Plan.” Many working people over age 65 do not sign up for anything other than Part A, as there is no cost for Part A, but the other parts come with a premium, which will already be covered through group health insurance.

How can I make sure I can still go to my doctor?

When you sign up for health insurance, and you want to continue to see a specific healthcare provider, you must ensure that the provider is in the network of the health insurance company. Be aware that some doctors are not in any network or may charge much more than what your health insurance company will pay. You will be responsible for paying the balance out-of-pocket. This is true even if you have PPO insurance and visit the doctor you like out of network. You can also call your doctor and speak to the administrative staff to find out if he or she is in the network.

Can I change health insurance plans?

You have the right to change your health insurance plan during the “Open Enrollment Period.” Under certain circumstances, you may be able to change your plan outside the Open Enrollment Period, called a “Special Enrollment Period.” The situations that can allow you to change your health insurance outside the Open Enrollment Period, include adding new members to your household. Some plans may not allow you to add a new member. In these cases, you can enroll the entire family in a new plan.

What are cost-sharing reductions?

Cost-sharing reductions are discounts that allow you to pay a lower amount for deductibles, copayments, and coinsurance. These discounts are offered in the “Silver” health insurance category. It is worth finding out if you are eligible for these deductions, as the savings can mount up over time, particularly if you or a family member has an ongoing need for expensive medications.

How do you choose the right health insurance plan?

It is essential that you select a health insurance plan that matches your individual needs and is affordable. Every individual and family has unique needs. Some are generally healthy and rarely visit the doctor, while others have health issues. These matters must be evaluated when choosing a health insurance plan, and it is advised that you work with a local insurance agent to assist you in finding the most appropriate health insurance plan. If you choose the wrong plan, you may have to wait many months before you have the chance to change your plan during the Open Enrollment Period.

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