Frequently Asked Questions

Question 1

What is health insurance and why do I need it?

Accepted Answer

Health insurance is a contract between you and an insurance company that helps cover the cost of medical care — from routine checkups to emergency surgery. Without it, a single hospital visit can cost tens of thousands of dollars. The right plan protects your finances and ensures you can access the care you need, when you need it.

Question 2

What's the difference between a premium, deductible, and copay?

Accepted Answer

Your premium is the monthly amount you pay to keep your coverage active — whether or not you use it. Your deductible is the amount you pay out-of-pocket for covered services before your insurance starts sharing costs. A copay is a fixed fee (like $30) you pay at the time of a doctor visit or prescription. Understanding these three numbers is key to choosing the right plan.

Question 3

What does 'in-network' vs. 'out-of-network' mean?

Accepted Answer

Insurance companies negotiate rates with specific doctors, hospitals, and clinics — these are 'in-network' providers. Seeing an in-network provider means lower costs for you. Out-of-network providers haven't agreed to those rates, so your costs will typically be higher. Some plans (like HMOs) require you to stay in-network; others (like PPOs) give you more flexibility.

Question 4

What types of health insurance plans are available?

Accepted Answer

The most common plan types are HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), EPO (Exclusive Provider Organization), and HDHP (High-Deductible Health Plan). HMOs typically have lower premiums but require referrals and in-network care. PPOs offer more flexibility but cost more. HDHPs pair with Health Savings Accounts (HSAs) and work well for healthy individuals who want lower monthly costs.

Question 5

How do I know which plan is right for my family?

Accepted Answer

The best plan depends on your family's health needs, budget, and preferred doctors. Consider how often you visit the doctor, whether you have ongoing prescriptions, and how much you can afford in monthly premiums vs. out-of-pocket costs. That's exactly what I help with — I'll walk you through your options and find a plan that fits your real life, not just a generic recommendation.

Question 6

Can I keep my current doctor?

Accepted Answer

It depends on the plan. Before enrolling, I always check whether your preferred doctors and specialists are in-network. If keeping your current doctor is a priority, we'll focus on plans that include them — so there are no surprises after you enroll.

Question 7

When can I enroll in a health insurance plan?

Accepted Answer

Most people enroll during Open Enrollment, which typically runs from November 1 to January 15 each year for ACA marketplace plans. Outside of that window, you can enroll if you experience a qualifying life event — such as losing job-based coverage, getting married, having a baby, or moving to a new state. Medicare has its own enrollment periods.

Question 8

What is a Special Enrollment Period (SEP)?

Accepted Answer

A Special Enrollment Period allows you to sign up for or change your health insurance outside of Open Enrollment if you've had a qualifying life event. Common triggers include losing coverage, getting married or divorced, having or adopting a child, or moving. You typically have 60 days from the event to enroll.

Question 9

Can I get coverage if I'm self-employed or don't have employer insurance?

Accepted Answer

Absolutely. If you're self-employed, a freelancer, or your employer doesn't offer coverage, you can shop for individual or family plans through the ACA marketplace or directly through carriers. Depending on your income, you may qualify for subsidies that significantly reduce your monthly premium. I can help you find out what you qualify for.

Question 10

What is Medicare and who qualifies?

Accepted Answer

Medicare is a federal health insurance program primarily for people 65 and older, as well as certain younger individuals with disabilities or specific conditions. It has several parts: Part A covers hospital care, Part B covers outpatient services, Part C (Medicare Advantage) bundles coverage through private insurers, and Part D covers prescription drugs.

Question 11

What's the difference between Medicare Supplement and Medicare Advantage?

Accepted Answer

Medicare Supplement (Medigap) plans work alongside Original Medicare to cover costs like copays, coinsurance, and deductibles. Medicare Advantage (Part C) replaces Original Medicare with an all-in-one plan from a private insurer, often including dental, vision, and drug coverage. The right choice depends on your health needs, budget, and preferred providers — I can walk you through both.

Frequently Asked Questions

Understanding Health Insurance

Choosing the Right Plan

Enrollment & Eligibility

Medicare & Seniors

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