Frequently Asked Questions
How do I make sure I’m not over-insured?
Public marketplace insurance has 10 primary regulations - called Essential Health Benefits. Many of these are important to ensuring that you're financially protected, but some also go under-utilized. If you don't need psychiatric therapy visits, maternity coverage, or drug and alcohol rehab for example, you may want a private plan for better day-to-day coverage.
What is HMO, EPO, PPO, or POS?
These are networks - your network determines which doctors or hospitals are accepted by the insurance.
Here's the breakdown:
HMO (Health Maintenance Organization): Typically Usable ONLY within county or ZIP code and requires a Primary Care Physician referral to see a specialist.
EPO (Exclusive Provider Organization): Usable ONLY within county or ZIP code, sometimes regional. No referrals are required.
PPO (Preferred Provider Organization): Nationwide or statewide coverage, no referrals needed. Often times, some benefits will apply out-of-network. This is best for travelers.
POS (Point-of-Service): Similar to an EPO network, but claims are filed at the time of the visit.
Can I get insurance outside of Open Enrollment?
Annual Open Enrollment for the ACA "Obamacare" plans is November 1 - January 15. During this time, anyone can apply for public medical insurance, whether qualifying for income-based subsidies or not. These plans require renewal on a yearly basis, so it's the busiest time of year.
Private plans are not subject to the same limitations, so they can be started or cancelled at any time.
Employer plans typically have their own, independent "open enrollment" period to switch coverage or renew, but are restricted outside of that time.
I'm healthy, are there discounts available?
With the affordable care act (ACA), there are no longer health-graded rates for most health insurance! Simply put - Obamacare plans do not base rates on health conditions or filter pre-existing conditions.
Private plans can still offer preferred rates for healthy individuals. These work on an approve-or-deny basis and do not typically require a physical exam.