The Insurance Twins are here to help you clearly understand how health insurance works. Do you still have questions? Scroll down to see our FAQs or contact us today.
What is health insurance?
Health insurance is a type of coverage that protects you from paying the full amount for regular health care or certain medical service or procedures. You pay a monthly premium, and your insurance provider helps you pay part or all of those expenses.
Why is health insurance so important?
Medical services can be expensive and unexpected. If you need emergency surgery, it could become a major financial burden without the help of insurance coverage.
How do I get health insurance?
That’s what we do best! You provide us your information (such as income, health needs, where you live, etc.) and we find a health insurance provider and plan that fits your needs.
What does health insurance cost?
All health insurance plans include a premium (monthly cost), deductible (the amount you pay out-of-pocket before the insurance begins covering a percentage of the costs), and copays (the fixed amount you pay after your deductible for covered health care services). A high deductible will lower your premium but will also have you paying more before the insurance kicks in. When looking at the benefits, if anything says “co-insurance,” you are looking at a medical encounter (a fancy phrase for using your plan) where you must meet your deductible. Once that’s exhausted, there’s a percentage of the remaining balance until you meet your out-of-pocket maximum.
How do I know which carrier is right for me?
When choosing a carrier, you’ll want to keep in mind the price, physician network, and benefits. Some carriers have smaller networks and than others. Some carriers may require referrals to visit specialists. We can help you compare and choose the right carrier for you!
What is the Affordable Care Act?
The Affordable Care Act was implemented in 2010 to accomplish three main goals.
Make health insurance available and affordable for more people.
Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level.
Support the innovation of new medical care and services to lower costs.
Learn more at healthcare.gov.
Do I qualify for the Affordable Care Act plans?
Anyone can get coverage from an Affordable Care Act plan. However, you may not be eligible for additional subsidies (or extra financial assistance). You are eligible for subsidies if:
- You live in the United States and are a citizen or legal resident.
- You are not currently incarcerated.
- Your income is not 400% above the federal poverty level or more.
What is Medicare Advantage?
Medicare Advantage plans are a type of Medicare plan offered by Medicare-contracted, private insurance companies. The Advantage plans offer Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) benefits and prescription drug benefits.
Do I qualify for Medicare Advantage plans?
If you are eligible for Medicare (you’re 65 or older or have a disability), you are eligible for Medicare Advantage. If you get Social Security retirement or Railroad Retirement benefits, you should be automatically enrolled in Medicare at 65.
What does “in-network” mean?
Networks (not TV networks) are the doctors, facilities, and hospitals contracted to accept patients on behalf of a plan. This one is simple to explain. The smaller the network, the lower the premium. Small networks help insurance companies manage costs but at the expense of reach and waiting times for consumers. We can check and teach you how to navigate the provider search tools to help you decide what’s best for you. If you like your doctor, you will want to be sure to choose a plan that your doctor accepts. We can help with that, too!
Will my prescriptions be covered by my plan?
Most insurance companies share similar formularies (watch out, that’s another fancy word for the list of all prescriptions they cover). They organize the prescriptions into generics and brand names as well as levels: tier 1, 2, 3, 4, sometimes even 5. Generics are going to be less expensive, and your co-pay will be lower based on the tier. Okay, now that we got that out of the way, you might ask how does it affect premiums? Plans will apply deductibles to some of the levels and apply lower or higher copayments to reduce premiums. If you’re taking medications for a chronic condition, have us help you do the math. Sometimes a lower premium means more.