Health Insurance for individuals and Families

Individual and Family Health Insurance FAQs

What are the new ObamaCare plans?

The new ObamaCare (nickname for the Affordable Care Act) plans fall into metal tiers that cover 60-90% of your health costs. The higher your premium the lower your out-of-pocket costs are for theAffordable Care Act Bronze, Silver, Gold, and Platinum plans. All these plans either must include or must offer the following:

  • Guaranteed Issuance: insurance companies can no longer not extend insurance or charge more to those with a preexisting condition
  • Essential Health Benefits: All new plans must incorporate these, which include $0 preventive care, maternity, and emergency services.
  • Premium Subsidies are available for those who qualify. These tax credits help with your monthly cost.
  • Cost-sharing subsidies are also available for those who qualify. These tax credits can lower your out-of-pocket costs by helping with your deductible, copayment, and coinsurance.

What is the best health plan for me?

While there is no one “best” health insurance plan, there are some plans that will be better suited to you and your family’s health care needs than others. Plans differ by how much you have to pay and how easy it is to get the services you need. And although no plan will pay for all the costs associated with your medical care, some plans will cover more than others. In choosing the best health insurance plan for you and your family, it helps to have a basic understanding of some of the key terms and trade-offs. With any health plan, you will make a basic payment called a premium, which is usually made monthly. In addition, there are often other payments you must make. These payments will vary by plan but essentially they are deductibles and co-payments. Click here to read about deductibles and co-payments and how they factor into selecting a health insurance plan.

How does the deductible work?

A deductible is a set dollar amount that you must pay toward your medical expenses before the insurance company starts to contribute their money.  Most health insurance plans have some a set deductible that you must pay each year. If you are healthy during any given year and have no medical expenses, then you don’t have to pay any money toward your deductible. But if you end up in the hospital or get lab work done, chances are you will have to make payments toward your doctor and medical bills until you satisfy your deductible. Generally (but not always), there is a trade-off between deductibles and premiums:  the higher the premium, the lower the deductible and vice-versa.  Click here to read more about deductibles and how they factor into selecting a health insurance plan.

Should I choose a PPO or an HMO?

A majority of clients tend to opt for a PPO, but individual preferences vary and you may want to refer to our glossary section to learn more if you are not familiar with these terms. Generally (but not always) PPOs have a larger network, allow you to see a specialist without a referral, and allow for some benefits even if you must see a doctor that is outside their wide network, or one that does not accept insurance.  HMOs usually make you select a primary care physician, then any time you need a specialist, you must go through that primary care physician to get a referral first.  HMOs also tend to have networks that are more regional in nature. On the other hand, HMOs also tend to have no deductibles and low copays. Like anything, the choice between an HMO and a PPO will involve trade-offs.  In this case, the trade-off tends to be between lower up-front costs for the HMOs, but a smaller network from which to choose a doctor and a more complex way in which to receive treatment each time you need it.

Can I buy health insurance for less if I buy directly from the insurance company?

No. Insurance companies charge the same exact premium whether the plan is purchased directly from the company or through an authorized agent. Medicoverage is an authorized agent for Blue Cross, Blue Shield, HealthNet, Kaiser, Aetna, UnitedHealth, PacificCare and other top providers. We work on your behalf at no additional charge to you.  Plus we are really wonderful people who are always willing to help—just ask our mothers.

What are my options for making my first payment?

You can usually make your initial payment by credit card, check or direct withdrawal from your checking/savings account.  Normally, you will not be charged until you have been approved. If you are not approved for coverage, your money will be refunded by the insurance company. Any financial information submitted over the web is kept private and secure.

Once I apply, can I get covered right away? Can I choose a future start date?

It usually takes a few weeks to start a plan. For traditional plans with an enrollment date prior to January 1, 2014, you will still be subject to medical underwriting. That’s just a fancy way of saying they can check your medical history, so it can take up to a month. As for post-dating, it depends on the plan and the state in which you live, you may also be able to choose a start date in the future—possibly as par out as 90 days if you wish.

What if I am denied coverage?

You may be turned down for the health plan for which you applied prior to January 1, 2014. After that, preexisting conditions are no longer a factor. However if you want insurance now and were turned down by one company, this does not necessarily mean that you cannot get health insurance at all. It just may mean that you’ll need to select a different plan and that plan may cost more. Regardless, you can work with the kind and gentle agents here at Medicoverage to help you get covered.

What is the difference between an in-network and an out-of-network medical provider?

An in-network medical provider is within the approved network of providers for a particular health plan. Out-of-network providers are not on the list. If you visit a doctor within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network doctor. In many cases, the insurance company will not pay anything for services you receive from outside their network.

How does OBGYN coverage work?

Obgyn coverage works differently for each plan available now. The ACA has already made changes to women’s health coverage, but as of 2014 the ACA gives women more coverage, such as all plans must cover maternity. Enter your zip code at the top of our Individual and Family Health Insurance Page, then follow the steps to get a quote.  There you’ll get to compare plans and get some basic info on OBGYN coverage.

If I have questions while completing an application, how can I reach you?

Please visit our Contact page

Next Steps? Check out our Health Insurance Glossary for easy to understand definitions of medical coverage jargon.