Question 1

Understanding Your Health Insurance Options

Accepted Answer

Health insurance is critical to helping you control your health care costs. You pay health care companies a premium, a set amount of money each month, and you get benefits to pay for your eligible health care expenses. This can include regular doctor checkups, treatment for injuries, and treatment for long-term illnesses.
We all know how expensive health care can be. That’s why it is so important to have health insurance so you’re prepared for when you or your family have medical needs. With health insurance, you can:Prepare for the unexpected.Access preventive care services like checkups, which are covered at 100%.You can purchase individual health insurance through the Health Insurance Marketplace on your own or we can help you work through your options. Although it’s called individual health insurance, you can also find plans to cover your family.

Question 2

Health Insurance Plans Available on the Marketplace

Accepted Answer

There are different types of Marketplace health insurance plans designed to meet different needs. Some types of plans restrict your provider choices or encourage you to get care from the plan’s network of doctors, hospitals, pharmacies, and other medical service providers. Others pay a greater share of costs for providers outside the plan’s network. Here is an overview of the types of marketplace plans available to you.Types of Marketplace plansDepending on how many plans are offered in your area, you may find plans of all or any of these types at each metal level: Bronze, Silver, Gold, and Platinum.Some examples of plan types you’ll find in the Marketplace:Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.Point of Service (POS): A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.Preferred Provider Organization (PPO): A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.For more information about the different options, visit www.healthcare.govThere are pros and cons for each option. It’s important to select the right option based on your needs. Contact us for guidance in selecting the right policy for you and your family. There is no cost to you for our help.

Question 3

Essential Health Benefits

Accepted Answer

Under the Affordable Care Act (ACA), fully insured small group and individual health plans on and off the Exchange/Marketplace must cover essential health benefits (EHB).Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.Essential health benefits under the Patient Protection and Affordable Care Act will include the following general categories:These essential health benefits include at least the following items and services:Ambulatory patient services (outpatient care you get without being admitted to a hospital)Emergency servicesHospitalizationMaternity and newborn care (care before and after your baby is born)Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)Prescription drugsRehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)Laboratory servicesPreventive and wellness services and chronic disease managementPediatric services including oral and vision careAccording to the Affordable Care Act, plans of all sizes that cover benefits designated as Essential Health Benefits, including self-funded plans, must cover these benefits with no annual limits or lifetime maximums.Footnote: This is a brief overview of Essential Health Benefits required by the Affordable Care Act. You should read thoroughly and understand the benefits offered before purchasing any insurance policy.

Question 4

Summary of Benefits and Coverage

Accepted Answer

Under the Affordable Care Act, health insurers and self-funded employers must provide a uniform Summary of Benefits and Coverage (SBC) to people who apply for and enroll in health policies.Insurance companies and group health coverage must provide you with:A short, plain-language Summary of Benefits and Coverage (SBC)A Uniform Glossary of terms used in health coverage and medical careThis information allows you to make “apples-to-apples” comparisons when you’re looking at different coverage.All individual and group health policies must use the same standard form to help you compare policies. The SBC also includes details, called coverage examples, which allow you to see what the policy would cover in two common medical situations: diabetes care and childbirth.The SBC is available for every policy in the Health Insurance Marketplace. You’ll find a link to it on each policy page when you enroll through the website.You can also ask for a copy from your insurance company or group health administrator at any time. All health policies must provide the SBC to you at important points in the enrollment process, like when you apply for or renew your policy. You can also ask for a copy of the Uniform Glossary to help you understand words used in health coverage and medical care.

Question 5

Preventive Health Services for Adults

Accepted Answer

Most health plans must cover a set of preventive services like shots and screening tests at no cost to you. This includes Marketplace private insurance plans.Preventive care helps you stay healthy. A doctor isn’t someone to see only when you’re sick. Doctors also provide services that help keep you healthy.Free preventive servicesAll Marketplace plans, and many other plans, must cover the following list of preventive services without charging you a co-payment or coinsurance. This is true even if you haven’t met your yearly deductible. This applies only when these services are delivered by a network provider.1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked2. Alcohol Misuse screening and counseling3. Aspirin use to prevent cardiovascular disease for men and women of certain ages4. Blood Pressure screening for all adults5. Cholesterol screening for adults of certain ages or at higher risk6. Colorectal Cancer screening for adults over 507. Depression screening for adults8. Diabetes (Type 2) screening for adults with high blood pressure9. Diet counseling for adults at higher risk for chronic disease10. HIV screening for everyone ages 15 to 65, and other ages at increased risk11. Immunization vaccines for adults (visit www.healthcare.gov for a full list)12. Obesity screening and counseling for all adults13. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk14. Syphilis screening for all adults at higher risk15. Tobacco Use screening for all adults and cessation interventions for tobacco usersFor a more detailed list, visit https://www.healthcare.gov/preventive-care-adults/ or call us for additional information.

Question 6

Short-Term Medical Insurance - Temporary Coverage

Accepted Answer

Outside of the individual market’s annual open enrollment period, a short-term health insurance policy might be your best option, especially without a qualifying event. Short-term plans generally provide the most comprehensive coverage available outside of open enrollment.Short-term policies have been around for some time. They are a good option for people who are between jobs or waiting for a new employer’s coverage to become effective. Unlike regular individual major medical plans, short-term health insurance policies are not regulated by the Affordable Care Act, and their sale is not limited to open enrollment windows.When does a short-term policy make sense?If you experience a qualifying event that triggers a special enrollment period, you’ll need to apply for an ACA-compliant policy (on or off-exchange) during your special open enrollment period, which lasts for 60 days in most cases. If you opt for a short-term policy instead, you won’t have the option to switch to an ACA-compliant plan after your open enrollment period ends. But if you miss open enrollment and haven't experienced a qualifying event, a short-term policy will provide you with up to six months of coverage in most states.Short-term plans are typically offered with a selection of premiums, deductibles, and benefit maximums. The policies are considerably less expensive than ACA-compliant major medical plans, so you may find that you can afford to purchase a plan with a low deductible and a high-benefit maximum. Plus, healthy applicants can secure immediate individual and family coverage, with plans that can start almost immediately. The policies also cover a range of physician services, surgery, outpatient and inpatient care. In addition, policyholders can often choose their own doctor and hospital without restrictions, though there may be financial incentives for using in-network providers.What short-term health insurance won’t coverShort-term major medical plans may be a great fit for healthy folks who just need temporary coverage, but the plans weren’t designed to cover everything, and they do not provide coverage for all of the ACA’s essential benefits.They typically won’t cover your routine office visits, maternity, mental health or preventive care, and they won’t cover preexisting conditions. They also still use medical underwriting, which means that applicants with serious pre-existing conditions may not be able to get short-term coverage. Be sure to check the list of exclusions on any policy.Give us a call to find out if short-term health insurance is option for you.

Question 7

Pre-65 Health Care Insurance

Accepted Answer

If you're under the age of 65 and need health insurance, there are 4 basic options available to you. We can help you determine the right choice based on your budget and needs.On-Exchange Plans (OBAMA CARE – Affordable Care Act)The plans are administered through the Centers for Medicare and Medicaid. Many people qualify for subsidies based on qualifying factors to help with their health care costs. This is typically the first step in finding the right plan for you, and we'll guide you through the process step by step.Off-Exchange PlansIf you don’t qualify for a subsidy, you can purchase health insurance directly from a carrier. We can help you compare plans and enroll in one that best meets your needs and budget.Short-term major medicalThese types plans are a great alternative for consumers looking for major medical coverage. Short-term health insurance, sometimes called Term health insurance or Temporary health insurance, is designed to bridge gaps in your health care coverage during times of transition. These plans allow you to:Start your coverage fast, as soon as the next day in many cases.Drop your coverage without penalty.Choose from a range of available deductible amounts.Apply for another term of coverage if needed.Hospital Indemnity InsuranceHospital indemnity insurance is a type of plan that pays a set amount per day, per week, per month, or per visit. In addition to a hospital per diem, a more comprehensive plan might feature payments for an ambulance trip, surgery or maternity visit, or increased payments for intense ailments such as stroke or cancer. Benefits can disburse in lump sums for short admittances, or on a daily or weekly basis during longer visits.As you can see, there are many options to choose from with different benefits and payment methods. We're here to help you through the confusion. Contact us today!

Question 8

Health Savings Accounts

Accepted Answer

The IRS has created a plethora of tax-advantaged savings accounts over the last few decades. But the Health Savings Account (HSA) may just be the most tax-friendly savings vehicle ever written into the tax code. HSAs not only help you financially today, but can continue providing tax advantages for many years down the road. Tax BenefitsThe cost of health care is increasing faster than nearly any other expense for Americans. Being able to pay for medical services and products in a tax-preferred way can save you hundreds, if not thousands of dollars from now through retirement. Health Savings Accounts provide the trifecta of tax advantages:Contributions are tax-deductibleEarnings on account balances grow tax-freeDistributions are tax-free for qualified purchasesEveryone is almost guaranteed to have health care expenses at some point in their lives. It only makes sense to find the most cost-effective ways to pay them. Limits and RestrictionsBecause of the tremendous tax advantages of HSAs, the IRS puts caps on the amount of money you may contribute every year. For 2026, individuals may contribute up to $4,400 while families may deposit up to $8,750 ($4,300 and $8,550 for 2025, respectively). That's about 2.3% more than the 2025 limits. For individuals 55 or older, an additional $1,000 "catch-up" contribution is allowed every year. But there is a catch. During the years in which you wish to contribute to an HSA, you must be enrolled in a high-deductible health plan. The IRS specifically defines how a plan qualifies as a high-deductible plan. For 2026, any plan with a deductible of at least $1,700 for individuals or $3,400 for a family. Further, a plan's total out-of-pocket maximum cannot exceed $8,500 per individual or $17,000 for a family. Spending HSA SavingsHealth Savings Accounts are fantastic vehicles to save on medical expenses today or to save for future expenses you might have in retirement. Regardless of when you decide to spend your HSA dollars, it is important to keep all receipts for medical expenses on file. Receipts are required whenever you wish to make a distribution.For those spending regularly, look for an HSA offering a checking account without maintenance fees and an accompanying debit card. Debit cards automatically track qualifying purchases when paying for medical services. They may also be used at pharmacies and retail stores but will require those receipts to back up your purchases.For those saving for future medical bills, consider an HSA with investment options. Since your account grows tax-deferred and distributions are tax-free, your investments are free from paying capital gains or income tax.Choosing an HSAWhether you have a high deductible through your employer or as a self-insured, you have the choice of which HSA provider to use. We can help you choose the best plan and HSA to maximize your savings on medical expenses and returns inside your HSA. If you have any questions, contact our office today.By contacting the phone number on this website, you will be directed to a licensed agent.

Question 9

Understanding the Affordable Care Act

Accepted Answer

There is much confusion around the Affordable Care Act (ACA) and the Health Insurance Marketplace. Here is some information to help you understand it a bit better.The ACA is a law that guarantees everyone has minimum essential health care coverage. You can’t be denied ACA health insurance coverage because of a pre-existing health condition, and you can’t be charged more for your plan because of it. It’s important to know what’s required under the ACA. Here’s what you need to know as you get started:Open enrollment, from November 1 to December 15, is your time to buy health insurance.In some instances, you can get tax credits to help you pay for your health insurance.Most everyone needs to have health insuranceWhen you’re looking for health care coverage, check the health plans you’re considering to be sure it says it meets “ACA minimum essential coverage.”There are several ways to buy health insurance:Your employerHealth insurance companiesHealth Insurance Marketplaces Keep in mindOpen enrollment is your time to buy health insurance.Open enrollment is a yearly time period set by the ACA. It’s your time to shop for individual health insurance and purchase a plan so you won’t pay a penalty at tax time.If you miss this window of time to purchase a plan, there are some exceptions called Qualifying Life Events that let you buy a plan during a Special Enrollment Period.In some instances, you can get tax credits to help you pay for your health insuranceDepending on your family situation and annual income, you may be able to get a tax credit to help offset your health insurance costs. You can visit Health Care to see if you qualify for a tax credit before you start buying your plan.

Health Insurance

Helpful Information

Understanding Your Health Insurance Options