Insurance FAQ Hub: Top 25 Health Insurance Questions, Answered
Ask any question about health, short-term, dental, vision, life or supplemental coverage. Search 7,400+ answers from licensed agents, and read each answer right here.
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The Basics of Health Insurance
Start here if you are new to coverage. This part of the Insurance FAQ Hub explains the words you will see on every plan.
β How does health insurance work?
You pay a monthly premium, and your insurance company helps pay for your medical care.
First, you pay a premium each month to keep your plan active. Then, when you get care, you pay part of the bill through your deductible, copays, or coinsurance.
After that, your plan pays the rest of your covered costs. Once you reach your out-of-pocket maximum, the plan pays 100% of covered in-network care.
Also, most plans cover preventive care, like checkups and screenings, at no cost when you use in-network doctors.
β What is a deductible?
A deductible is what you pay for covered care before your plan starts sharing the cost.
For example, with a $3,000 deductible, you pay the first $3,000 of covered services. After that, you usually pay only a copay or coinsurance.
Still, many plans cover preventive care and some doctor visits before you meet the deductible. In general, lower premiums come with higher deductibles.
β What is the difference between a copay and coinsurance?
A copay is a flat fee, while coinsurance is a percentage of the bill.
For instance, you might pay a $30 copay for a doctor visit. By contrast, with 20% coinsurance, you pay $200 of a $1,000 bill.
Usually, coinsurance starts after you meet your deductible. Both copays and coinsurance count toward your out-of-pocket maximum.
β What is an out-of-pocket maximum?
It is the most you will pay for covered in-network care in one plan year.
Your deductible, copays, and coinsurance all count toward it. Once you reach it, your plan pays 100% of covered in-network care until the plan year ends.
However, your premiums and out-of-network bills do not count. The federal government sets the highest limit allowed each year, and many plans set theirs lower.
Health Insurance Costs and Savings
Price is the top worry for most shoppers. So this Insurance FAQ Hub section shows how to understand costs and lower them.
β How much does health insurance cost per month?
Your price depends on your age, zip code, income, household size, tobacco use, and plan tier.
For example, a 25-year-old usually pays much less than a 60-year-old for the same plan. Likewise, prices change from one county to the next.
Fortunately, many people qualify for premium tax credits that lower the monthly price. In fact, some households can find bronze plans for $0 a month after credits.
Because prices change every year, compare plans before you renew.
β How do I qualify for a health insurance subsidy?
Premium tax credits are based on your expected household income and family size.
In general, you may qualify if your income falls between 100% and 400% of the federal poverty level. In states that expanded Medicaid, help usually starts at 138%.
However, the extra federal credits from recent years have ended, so most households above 400% no longer get help. Still, the credit can lower your premium right away.
Also, update your income if it changes, because you may owe money back at tax time.
β How can I get cheap health insurance?
Start by checking tax credits, Medicaid, and bronze or silver plans in your area.
First, see if you qualify for premium tax credits or Medicaid. Next, compare bronze plans for low premiums, or silver plans if you qualify for extra savings.
You can also choose an HMO or EPO network to lower your premium. Finally, compare several carriers, because prices for similar plans can vary a lot.
β Do I qualify for Medicaid?
It depends on your income, household size, and the state you live in.
In states that expanded Medicaid, most adults qualify with income up to 138% of the federal poverty level. However, about ten states have not expanded Medicaid for most adults.
In those states, many adults without children do not qualify. Even so, children often qualify for CHIP at higher incomes, and you can apply any time of year.
β What is an HSA, and who can open one?
An HSA is a tax-advantaged savings account for medical costs, paired with an HSA-eligible plan.
Your contributions are tax-deductible, and withdrawals for medical costs are tax-free. Also, unused money rolls over, and the account stays yours if you switch jobs.
To contribute, you need an HSA-eligible high-deductible plan. Now, bronze and catastrophic marketplace plans qualify too, which opens HSAs to more families.
Enrollment and Timing Questions
Timing matters with health insurance. Here, the Insurance FAQ Hub shows when you can sign up and how fast coverage starts.
β When is open enrollment for health insurance?
Open enrollment for marketplace plans starts November 1 every year.
On HealthCare.gov, open enrollment runs through January 15. Enroll by December 15 so your coverage starts January 1. However, some states run their own marketplace with different deadlines.
Outside open enrollment, you generally need a qualifying life event to sign up. Because deadlines vary, check your state early or call us for help.
β Can I get health insurance outside open enrollment?
Yes, if you have a qualifying life event, like losing coverage, moving, marrying, or having a baby.
These events open a Special Enrollment Period, which usually lasts 60 days. In addition, Medicaid and CHIP accept applications all year.
Short-term plans also accept applications year-round in many states. So missing open enrollment does not always mean waiting a full year.
β How long does it take for health insurance to start?
It depends on when you enroll and the type of plan you choose.
During open enrollment on HealthCare.gov, plans chosen by December 15 start January 1. With a Special Enrollment Period, coverage often starts the first day of the next month.
Meanwhile, Medicaid can sometimes cover bills from before you applied. Short-term plans can start within days in many states.
β What happens to my health insurance if I lose my job?
Losing job-based coverage gives you a 60-day window to pick a new plan.
First, you can keep your old plan through COBRA, although you usually pay the full premium plus a fee. Alternatively, a marketplace plan is often cheaper.
In fact, your lower income may qualify you for bigger tax credits or even Medicaid. A short-term plan can also bridge a short gap in many states.
β Can I stay on my parentsβ health insurance until 26?
Yes. Under the ACA, you can stay on a parentβs plan until you turn 26.
This applies even if you are married, live on your own, or are not a student. Also, you can stay on it even if your job offers coverage.
When you turn 26, losing that coverage opens a Special Enrollment Period. Then you can choose your own plan without waiting for open enrollment.
Plan Types and Coverage
Not all plans work the same way. These answers help you compare networks, tiers, and benefits.
β What is the difference between an HMO and a PPO?
An HMO keeps costs lower with a set network, while a PPO costs more but offers more freedom.
With an HMO, you usually pick a primary care doctor and need referrals for specialists. In addition, out-of-network care is generally covered only in emergencies.
A PPO, on the other hand, lets you see specialists without referrals and pays for some out-of-network care. Meanwhile, EPO and POS plans fall in between.
β How do I check if my doctor is in network?
Search your plan directory, then confirm with the office and your insurer.
Start with the network name on your insurance card. Then search that network in the carrier directory using your exact plan name and ZIP code.
Next, call the doctorβs office and your insurer to confirm. Write down the date, the repβs name and a reference number in case the directory is wrong.
β What are bronze, silver, gold, and platinum plans?
Metal tiers show how you and your plan split costs, not the quality of care.
On average, bronze plans pay about 60% of costs, silver about 70%, gold about 80%, and platinum about 90%. So bronze has the lowest premium but the highest costs at care.
Silver is the only tier with extra cost-sharing savings for lower incomes. Gold and platinum, by contrast, suit people who see doctors often.
β What does health insurance cover?
ACA plans cover ten essential health benefits.
These include doctor visits, emergency care, hospital stays, maternity care, and mental health care. Prescription drugs, lab tests, rehab, preventive care, and childrenβs dental and vision are covered too.
Still, each plan has its own drug list and doctor network. So check your doctors and medications before you enroll.
β Does health insurance cover pre-existing conditions?
Yes. ACA marketplace plans cannot deny you or charge more because of a pre-existing condition.
This includes conditions like diabetes, asthma, cancer, and pregnancy. Plus, coverage starts right away with no waiting period.
However, short-term plans are not ACA plans, so they can exclude pre-existing conditions. If you have ongoing health needs, an ACA plan is usually the safer choice.
β Does health insurance include dental and vision?
Adult dental and vision are usually not included, so most adults need separate plans.
Childrenβs dental and vision count as essential health benefits. Adults, however, usually buy standalone dental and vision coverage.
Fortunately, these plans are often affordable, and many cover cleanings and eye exams at 100%. You can usually add them any time of year.
Special Situations
Self-employed, between plans, or unsure where to start? Then these Insurance FAQ Hub answers cover questions that do not fit a box.
β What is short-term health insurance?
Short-term health insurance is temporary coverage that fills gaps between major medical plans.
It often costs less than an ACA plan, and you can apply any time of year. However, it is not ACA coverage, so it can exclude pre-existing conditions and limit benefits.
It also does not qualify for tax credits. Vivna offers UnitedHealthcare short-term plans in many states, plus longer Tri-Term plans in some states.
β Is Obamacare the same as marketplace insurance?
Yes. Obamacare, ACA plans, and marketplace plans all describe the same coverage.
The Affordable Care Act created these plans and the marketplaces that sell them. You can enroll through HealthCare.gov, your stateβs marketplace, or a licensed broker.
Best of all, the price is the same either way. Carriers like Ambetter, Oscar, UnitedHealthcare, and Molina sell these plans in many states.
β What is the best health insurance for self-employed people?
Most self-employed people choose an ACA marketplace plan.
Because tax credits follow your income, a marketplace plan can be very affordable. Also, you may be able to deduct your premiums on your taxes.
Some people pair a bronze plan with an HSA for extra tax savings. Meanwhile, short-term plans can work for healthy people between options in many states.
β Is there a penalty for not having health insurance?
There is no federal penalty, but a few states still charge one.
California, Massachusetts, New Jersey, Rhode Island, and Washington, D.C. require most residents to have coverage. If you go without it there, you may owe a penalty at tax time.
Even without a penalty, one hospital stay can cost tens of thousands of dollars. That is why coverage still matters everywhere.
β Does using a health insurance broker cost more?
No. A licensed broker compares plans for you, and your premium stays the same.
Carriers pay brokers, so you pay the same price as buying direct. Meanwhile, a broker compares many carriers, checks your savings, and confirms your doctors are in network.
Vivna is an independent broker appointed with 50+ carriers in 48 states. So call 888-730-6031 for free help today.
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