There’s no shame in asking questions. In fact, we encourage them. Here are some of the most frequent things we’re asked as well as some common misconceptions we clear up.
While there are many different types of health insurance on the individual market, most do NOT cover pre-existing conditions. The term “pre-existing condition” refers to any condition, symptom, etc. that existed prior to the effective date. Each type of plan has its own determined policy outline as to how it will (or will not) provide coverage for pre-existing conditions.
“ObamaCare” is a colloquial term that refers to plans that meet the requirements of the Affordable Care Act legislation. Everyone is eligible for these plans. However, estimated taxable income is utilized to determine how much assistance one is eligible for, if any.
You can cancel a plan any time you like. And most of the off-exchange plans can be written any time during the year. However, they do come with restrictions on coverage. Enrollment eligibility for ACA/Marketplace plans is limited to the Open Enrollment Period, unless you have a qualified life event.
Many don’t know the difference, but it’s dangerous when someone thinks they know, and are incorrect. The difference between an HMO and a PPO lies in how the plan performs should you end up at a medical facility that is out-of-network. With a PPO, a secondary set of benefits provides coverage in this event. However, with an HMO, there is typically no coverage at all outside of the network.
This term is often misunderstood as the point at which the insurance plan “takes over” payment for medical expenses. That is actually what is referred to as the “maximum out-of-pocket”. More specifically, the deductible is the financial threshold one must meet before the plan starts contributing at a predetermined percentage for any expenses subject to the deductible. Unfortunately, there are many off-exchange plans that offer “no annual deductible” as a benefit, which is misleading and dangerous as these plans usually have no maximum out-of-pocket, and therefore, no catastrophic coverage at all.
Health insurance is not intended to make medical care less expensive, but rather cap annual expenses in the event of catastrophic loss. Increasing comprehensive care to include low cost copays can be done, but is more expensive.
Carriers are large insurance companies that host hundreds of networks. Providers may contract with some networks within a particular carrier, but not all. So, while a provider may accept some plans with a particular carrier, they may not accept others from the same carrier. Always check.
Many refer to non-ACA plans as “private” health insurance, and ACA plans as “government” insurance. However, the ACA/Marketplace is made up of ONLY private plans, as well. The only “government” plans are Medicare, Medicaid, and VA Benefits.
Many people think they don’t qualify for monthly premium assistance on the ACA/Marketplace, when they actually do.
Find the best health insurance plan for YOU by working with American Health Options.