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Health Insurance FAQ: Over 100 Questions and Answers

With well over 100 questions, this is the ultimate health insurance FAQ along with video explainers!

ACA - Obamacare Open Enrollment

How to apply or sign up for Obamacare

You can sign up for Obamacare health insurance during the Open Enrollment Period which occurs once a year. The next Open Enrollment Period is November 1st and ends on December 15th. You can also apply for Obamacare if you lose insurance coverage through a job, or other qualifying life events. To sign up for Obamacare outside of the Open Enrollment Period you will need to be granted a Special Enrollment Period. For more information about signing up for Obamacare visit healthcare.gov.

What is Open Enrollment?

For Affordable Care Act Plans, Open Enrollment is the period of time occurring once a year where you can purchase health insurance through the government website. The Open Enrollment Period is a limited window of time, typically lasting around 6 weeks.

If you are enrolling in health insurance through your employer, then you should pay close attention to when its Open Enrollment period is. Often, the period parallels the Affordable Care Act Open Enrollment period, but this is not always the case as it is up to the employer as to when to schedule.

When is Open Enrollment?

Open Enrollment Period begins November 1st, 2019 for Affordable Care Act Plans, and ends on December 15th. Health Insurance plans purchased during Open Enrollment Period will become effective on January 1st, 2020.

When Does Open Enrollment End?

Open Enrollment for Affordable Care Act health insurance ends on December 15th. If you missed the Open Enrollment Period you may be able to qualify for a Special Enrollment Period if you lose job-based coverage, have a baby, get married, or experience certain other life changes.

What are my options outside of open enrollment?

If you don’t enroll in a health insurance plan by the open enrollment deadline, Short term health insurance is an option that is available year-round and can last up to 36 months in some states.

Can I get health insurance coverage outside open enrollment?

Yes. If you missed the deadline for Open Enrollment and need ACA health insurance, you may be able to qualify for a Special Enrollment Period. This can be granted if you lose job-based coverage, have a baby, get married, or experience certain other life changes.

How can I get health insurance after Open Enrollment?

You can purchase a short term health plan or hospital indemnity insurance through a licensed online health insurance agency such as AgileHealthInsurance.com until the next Open Enrollment Period begins.

What is the penalty for not having health insurance? Is health insurance required by law?

There is no tax penalty for not having Affordable Care Act compliant health insurance. If you did not have health insurance in 2018, you may be subject to a tax penalty unless you could not afford health insurance or have an extenuating circumstance. The amount of the penalty depends on your yearly household income. It will either be $695 per person or 2.5% of yearly household income, whichever is the greater amount, though it is charged on a pro-rata basis depending on the amount of time during the year you were not insured by an ACA compliant plan.

Is it a law to have health insurance in 2019?

No. The individual mandate that compelled Americans to have health insurance was repealed for 2019, which means Americans without health coverage will no longer be subject to the tax penalty. However, with hospitals marking up healthcare pricing as much as 1000%, going without some form of health insurance is very risky.

What is the health insurance marketplace?

The Health Insurance Marketplace (or Exchange) is where you go to buy health insurance online. The federal government operates a Marketplace on HealthCare.gov. Licensed agencies such as AgileHealthInsurance.com offer non-ACA health insurance plans. You can shop for health insurance plans, learn more about the different options, or get in contact with an agent for further assistance.

Can I buy health insurance that is not Obamacare?

Yes, you can buy short term health insurance or hospital indemnity insurance that is not Obamacare any time through an online insurance agency like ours.

Is it too late to sign up for Obamacare?

Yes. The time to do that was in 2018. You can sign up for Obamacare, also known as the ACA open enrollment, near the end of 2019, starting on November 1st and ending December 15th.

How do Obamacare subsidies work?

Obamacare subsidies are government discounts intended for individuals and families who need help paying for health insurance. They are also known as advanced premium tax credits (APTC), and work on a sliding scale where not everyone receives the same level of assistance. Your income has to be within the 100-400% range of the Federal Poverty Level (FPL) to receive a subsidy. The Federal Register reported that the poverty level for an individual is $12,140 in 2018, although this number depends on where you live and the size of your household. If you are below 100% of the FPL you will not be eligible for a subsidy, but you can enroll in Medicaid and receive health insurance coverage without premium costs.

Short Term Health Insurance

What are other options for health insurance?

Besides traditional health insurance through an employer or the government, the next best option is short-term health insurance, which can provide next day coverage and they can be cancelled anytime.

What is short term health insurance?

Short Term Health Insurance plans provide coverage in case of unexpected accidents and illnesses and offers major medical type benefits. The coverage is for a defined period of time. The length of coverage varies by state, from 90 days up to 364 days and can be reapplied or renewed for up to 36 months in many states. There are no open enrollment period restrictions, and all short term policies are underwritten based on the health of the individual to determine the premium. Though it can vary by states, most short term health insurance plans do not cover pre-existing conditions so if you have a question or are concerned, you should speak with a knowledgeable insurance agent.

What does short term health insurance cover?

Short-term health insurance covers doctor visits, hospitalizations, emergency care, lab tests, x-rays, and other common medical needs. Typically, it does not cover pre-existing conditions, though there can be exceptions in some states.

Is short-term health insurance Obamacare?

No. Short Term Health Insurance is a streamlined insurance plan that’s different from Obamacare in three key ways:

  1. Short Term Health Insurance is advantageous for some people because the monthly premiums are generally less expensive than those of an ACA plan or one that covers all of the ACA’s essential minimum benefits (e.g. maternity mental health).
  2. Short term plans are available for purchase year-round and can now be bought in increments of up to 364 days. Some carriers even offer plans that are renewable for up to 36 months depending on state regulations.
  3. Short-term health insurance involves an application. Depending on your health status, your application may be declined or your pre-existing condition may be excluded. Obamacare guarantees that all applicants and their pre-existing conditions will be covered.

When can I apply for short-term health insurance?

You can apply at any time. There is no fixed open enrollment period. On agilehealthinsurance.com, you can submit an application in minutes. If approved, your insurance policy can become active within 24 hours of submission."

How long can you have short term health insurance?

Short term health insurance coverage can last for days, weeks, months, or even years. Coverage begins the day after you’re approved and you can cancel it anytime, while some states offer it for up to 36 months.

Can I renew my Short Term Health Insurance policy?

Since the laws regarding Short Term Health Insurance are largely based on state laws, it depends on where you live. Some states allow you to reapply and maintain your same coverage for up to 36 months, while others only allow you to have a Short Term policy for up to 364 days. This is not the same as renewing a plan.

To reapply, you must submit a new application with your up-to-date health information and the carrier will determine whether to underwrite a new policy for you. There is a chance that your application may be declined if you’ve contracted a now pre-existing condition, but if not, your re-application can be processed within 24 hours.

Call agilehealthinsurance.com at (800) 314-5594 to learn more about reapplying for Short Term health Insurance.

What about cancelling a short-term plan?

You can cancel your plan and receive a full refund within the first ten days of the effective date of your plan. For cancellation beyond this ten-day window, you simply email or call us with your reason for cancelling. We try to handle cancellation requests within 24 business hours of receiving them.

What about pre-existing conditions?

Typically, short term health insurance costs less than Obamacare because it doesn’t cover pre-existing conditions. Also, there is an application with health questions that will determine your eligibility for the plan you’re interested in. Pre-existing condition coverage exclusions can vary by state, and so if you have questions, you should contact a licensed agent.

What conditions on the application will make me ineligible for short-term insurance?

In most states, if you have been diagnosed, treated, or taken medication for any of the following conditions within the last five years, Short Term Health Insurance cannot be issued: Cancer or tumor, stroke, heart disease, including heart attack, chest pain or a history of heart surgery, COPD (chronic obstructive pulmonary disease) or emphysema, Crohn's disease, liver disorder, degenerative disc disease, rheumatoid arthritis, kidney disorder, diabetes, degenerative joint disease of the knee, alcohol abuse or chemical dependency, or any neurological disorder, HIV or AIDS, or if you are now pregnant or in the process of adoption.

If you are looking for insurance to cover your pre-existing conditions, we can refer you to an agent who can help you find a health insurance plan to cover these conditions:

  • For ACA/Obamacare Plans: 888-475-8043
  • For Medicare Plans: 855-382-4440

Some states do require short term health insurance to cover a portion of pre-existing conditions, but the rules are in flux. If you have questions, you can reach out to a licensed agent.

Where are health insurance brokers near me?

Health insurance brokers are always available for questions and assistance with signing up online or over the phone. You can find licensed health insurance brokers online to help you with Short Term Health Insurance on websites like AgileHealthInsurance.com.

What qualifies as pre-existing conditions?

Any condition that you have prior to applying for health insurance qualifies as pre-existing.

How are pre-existing conditions determined?

Affordable Care Act plans will cover pre-existing conditions. Short term health plans can deny an applicant or exclude coverage of pre-existing conditions.

Pre-existing conditions are determined in the underwriting process when applying for certain kinds of health insurance like short term health insurance. Applicants are asked questions about their medical history, and may be asked to provide up to date medical records.

Will I pay more for health insurance if I'm unhealthy?

Under the Affordable Care Act, you are not charged for health insurance based on your health status. You will not pay more for health insurance if you have pre-existing conditions if you buy a plan through the Affordable Care Act, but you will if you use tobacco. There are three other factors which can also increase your health insurance rates: age, location, and size of your family.

Insurance Basics

How to get health insurance?

You can get health insurance a few different ways. Depending on where you work, you may be able to get health insurance through your employer. If you are unemployed, or your employer does not provide health insurance (or if it is unaffordable), you can look at medical plans available on the HealthCare.gov. The Affordable Care Act mandates ten essential health benefits be included with every major medical plan, which makes the coverage extremely comprehensive. To help offset the costs there are options available to those who qualify, referred to as subsidies. You can buy ACA/Obamacare health insurance through HealthCare.gov during the Open Enrollment Period. Open Enrollment starts that happens once a year in November and December.

There is a way to get health insurance outside of OEP and that’s if you qualify for a Special Enrollment.

Special Enrollment applies if you lose coverage through a job, experience certain life events (moving, getting married, having a baby), or need health insurance and do not quality for Medicaid benefits. However, if you are not granted a Special Enrollment, you’ll need to wait until the next Open Enrollment Period which starts in November. In the meantime you can look into a short term health insurance plan to protect you in case of unexpected accidents or illnesses. You can apply for a short term health insurance plan any time of year. Short term health insurance plans offer streamlined benefits such as hospital and doctors’ services, which cost less than ACA plans and can be active as early as the next day in some cases. Short term health insurance plans are not, however, the same as ACA plans and often don’t provide the same level of coverage for conditions such as pregnancy and mental health.

What is health insurance?

Health Insurance is a contract you make with an insurance carrier to pay for healthcare expenses incurred during a defined length of time. The details of your insurance policy determine the benefits and the amount you will pay monthly (referred to as the “premium”). Medical expenses resulting from illness or injury can be either reimbursed by the insurance company, or paid directly to the provider.

How do out of pocket maximums work?

Your out-of-pocket maximum is the total amount which you have to pay for covered medical expenses in a given year. The money you pay for your deductible, co-pays, and coinsurance contribute to the out-of-pocket maximum, but not your premiums. Plans with lower premiums will generally have higher out-of-pocket limits.

In 2019, an Affordable Care Act bronze-level plan provided on average an out-of-pocket limit of $7,900 for an individual plan and $15,800 for a family plan. The insurance company will pay for all covered expenses past that amount, at no additional cost to the policyholder besides the premium. ACA plans have no policy limits but short term health insurance plans do (e.g. $1 million).

When did health insurance start?

The origins of health insurance date back to the mid 1800s when the first U.S. insurance company started offering accident insurance. Medical and hospital expense insurance were later introduced in the 1920s. Employers began offering health insurance benefits starting in 1929 and this accelerated during the Second World War, when American employers used health insurance to attract workers because there was a wage freeze. And did you know Medicare and Medicaid programs were signed into law in 1965?

How does health insurance work?

The health insurance system in the US is similar to other kinds of insurance. You choose a plan that works for your specific situation, pay a monthly premium, and the insurer will assume risk on your behalf. The benefits of the policy vary depending on the details of your policy. There are various factors that affect the cost/benefit levels of your health insurance plan, including: premium, deductible, co-payment, coinsurance, and exclusions.

What is private health insurance?

Private health insurance (also known as "commercial" health insurance) refers to health insurance plans that are not receiving governmental payments.

What is temporary health insurance?

Temporary health insurance, also known as short term health insurance, short term medical, private insurance, or term health insurance, can be applied for during or outside of open enrollment 12 months out of the year and cancelled anytime. Temporary health insurance coverage can last for as little as a month or as long as 3 years, depending on what state you live in.

What is the difference between in-network and out of network providers?

The difference between in-network and out of network providers is how much it costs you as the policyholder. Doctors and hospitals who are in-network have made agreements with the insurance company to offer a negotiated, and in many cases, lower rate to their members. Out of network providers may not be covered by your policy so they may charge you their highest rates, so it’s always important to check with your health insurance company first before receiving services.

How does a POS plan work?

POS stands for “Point Of Service,” and the plans include a network of providers who offer discounted services. POS plans are similar to HMO plans where you choose a primary doctor within the network. You can choose the benefit levels of the plan which will determine how much it will cost. In most POS plans you’ll pay a monthly premium, and have to meet a deductible before insurance benefits are applied. You’ll also pay a copay and coinsurance once the deductible is met.

What is Co-Op health insurance?

Co-Op health insurance is a kind of mutual insurance plan that is also known as “Community Operated and Oriented Plan Program.” This program funded around 23 non-profit, member-owned health plans from the Affordable Care Act in 22 states (Oregon had two). All of these health plans provided individual Qualified Health Plans (QHP) in the Federally Facilitated Marketplace (FFM) and/or state exchanges. There were also some which provided employer group coverage. Most programs were shut down after the federal default on the risk corridor program in 2015.

What is single payer health insurance?

Single payer health insurance refers to a system where all medically necessary services would be covered by a single public system. Healthcare costs would be financed by taxes, and cover all residents within the system. The U.S. is not a single payer system, but when politicians discuss it as an option, they often use the phrase “Medicare for all.”

What does deductible mean in health insurance?

The deductible is the total amount which you as the consumer need to first pay toward any medical expenses you receive during your coverage period. The deductible is a separate expense from your monthly payment. Covered medical expenses after this amount will be paid by the health insurance company in accordance with the policy although you may be subject to copays and coinsurance.

For example: if your deductible is $1,000 and you have a $3,000 hospital bill, you would pay $1,000 and the health insurance company would pay most of the remaining $2,000 (you may be subject to coinsurance up to the policy’s max out of pocket amount).

A deductible is different than a copay. Many people confuse a deductible with a copay and fear that a routine doctor’s visit will not be covered until they meet the full deductible. Routine services, however, usually have a copay in which you pay a set amount for the service. For example, if you go for a routine check-up, and check-ups are covered under your plan with a copay of $50, then you pay the $50.

How does my deductible impact my premium?

Generally speaking, the higher the deductible, the lower the premium. Higher deductible plans are beneficial for people who are in good health but want to be covered in case of an emergency. Although you will still need to pay the amount of the deductible, it’s still cheaper than the cost of most emergency procedures. On the other hand, people who do have a lot of medical expenses (such as surgeries or services such as physical therapy) would save more money by opting for a lower deductible plan. It is possible to find a health insurance plan with no deductible requirement, however it would most likely have higher monthly payment.

Can I have Medicare and private insurance?

Your private insurance will work concurrently with Medicare to cover additional costs. If you have other forms of health insurance, Medicare works as either the primary or secondary payer. If you have Medicaid (known as a “dual eligible”), Medicare would pay first up to the limits of its coverage.

What is coinsurance in health insurance?

Coinsurance is the percentage of a medical bill that you’re responsible for paying once you have met your deductible after the insurance company pays their part. The amount that the health insurance company pays will vary based on your benefits. Coinsurance is paid until you reach your maximum out of pocket limit.

What is a copay in health insurance?

Copay, or “copayment” is the payment which the consumer may pay when they go to a doctor, specialist, or other medical service depending on the plan. This is a separate cost from the monthly premium, and is not applied towards your deductible. In general, the higher the premium, the lower the copay. Conversely, lower premiums will typically have higher copays.

What kind of health insurance does congress have?

Members of Congress and their staff are exempted from the Federal Employees Health Plan (FEHP) and are expected to purchase their insurance through the federal health insurance exchange. They are provided a stipend to help pay for their coverage.

What is the best health insurance company?

The best health insurance company is the one that provides an affordable plan that works for your budget, and your specific medical situation. Some of the most well known health insurance companies include: Kaiser Permanente, BlueCross/BlueShield, UnitedHealthCare, Aetna, and Cigna.

How to get health insurance fast?

Visit a health insurance quote page and you can compare different quotes and apply in minutes and be covered by the next day in some cases. For example, with short term health insurance, your coverage can begin within 24 hours, though there may be a waiting period (typically 5 days) before an illness will be covered.

Do you have to have your insurance card to go to the doctor? Can I go to urgent care without an insurance card?

You can go to the doctor or urgent care if you do not have your insurance card, but you will have to provide certain information to help locate your policy. This could include your Member ID number, your Social Security Number, the Group/Policy Number, and the name of the health insurance company. You can contact your insurance company to request this information if you do not have it, or request it from your employer’s HR Department.

What’s the best health insurance plan for me? Which health insurance is best for me? What should I look for in a health insurance plan?

You should look for a health insurance plan which is a good fit for your individual or family situation. The best health insurance plan is one which you can afford on a monthly basis, and provides coverage when you need it most. There are many options that work depending on your individual or family needs. Check with your employer to see which health insurance options you have. If you do not have an employer-based option and have pre-existing conditions you should look into an ACA plan, and government subsidies if you cannot afford it at the full rate. If you have low income you can look into high deductible plans which will have lower monthly payments, although the benefits will be more limited.

What is individual and family health insurance?

Individual health insurance refers to a policy for only one person. Family health insurance includes your spouse and/or children.

Do I need special health insurance when traveling abroad?

Most health insurance plans do not include coverage for traveling abroad, although some Medicare Advantage plans have the option. In most cases however, if you travel outside of the country you will not be covered by your health insurance plan. In order to stay covered when outside of the country you would need to purchase travel insurance for the duration of your trip.

Employment based insurance

How to get health insurance without a job?

Although many people have insurance through their employer, you don’t need a job to get health insurance. You can purchase a plan on healthcare.gov during the Open Enrollment Period from November 1st to December 15th. If you don’t have a lot of money for health insurance, you can look into a high deductible plan which will have the lowest monthly payments. You may also get government savings on an Affordable Care Act Plan based on your income and household size - known as a subsidy. It is also possible to qualify for free or low-cost coverage through Medicaid programs or the Children’s Health Insurance Program (CHIP).

What happens if I miss open enrollment at work?

It depends on the company, but if you miss the open enrollment period to sign up for health insurance at work, you may have to wait until the following year to enroll. If you already receive health insurance from your employer, you have the option to change your plan during the employer’s open enrollment period. If you take no action you will be automatically renewed into the same plan or a comparable plan if your current plan is eliminated. You also can purchase a short-term health insurance plan to keep you covered for illnesses and accidents until the next open enrollment period.

How to buy health insurance without a job?

If you're unemployed and don’t have a lot of money for health insurance, you can look into a high deductible plan which will have the lowest monthly payments. You can also get government support on an Affordable Care Plan based on your income and household size. You may be able to qualify for free or low-cost coverage through Medicaid programs or the Children’s Health Insurance Program (CHIP).

If you are unsure about how long you will be unemployed, but are comfortable with the streamlined benefits and pre-existing condition exclusions, a short term health insurance plan may serve as a bridge until you obtain employer-based health insurance.

Do employers have to offer health insurance?

Employers do not have to offer health insurance to employees, but they may be subject to a tax penalty if they do not. The Affordable Care Act requires large employers with over 50 full time equivalents to offer affordable health insurance. Affordable is defined as the lowest cost self-only health insurance option offered can not exceed 9.86% of the employee’s annual income. Smaller employers are not subject to the tax penalty for not offering health insurance.

How long is health insurance active after termination?

After the termination date on your employment, your employer-sponsored health insurance will end (usually at the end of the current month). You can continue your coverage at your own expense through COBRA (if qualified), or purchase a new plan either through the Marketplace or a private company, such as a licensed health insurance agency.

What is COBRA health insurance?

COBRA health insurance refers to the Consolidated Omnibus Budget Reconciliation Act that was passed in 1985. The Act mandates that health insurance be made available to employees and their dependents after leaving their job or having their work hours reduced. You can continue your coverage through COBRA for up to 18 months if you lose a job, unless you were fired for gross misconduct. You can keep COBRA coverage for up to three years in some circumstances, and you pay the total amount of the plan without the employer sharing the expense. Usually, this is 102% of the cost of the policy.

I'm self employed. Is it better for me to buy health insurance through a broker, or through the exchange?

If you are self employed, you have several options to buy health insurance. You can always research the different plans yourself, get free quotes online, and purchase the one which works best for you. Health insurance brokers can help you buy health insurance over the phone, in person, or online, and are a good option especially if you have questions about the process. Brokers can also help determine if you’re eligible for any Obamacare subsidies, and there’s no additional charge to you for buying health insurance through a broker.

How to check if I have health insurance?

If you’re not sure whether you have health insurance, ask your employer if they provide coverage and if you’re enrolled in the plan. If not, you’ll need to buy your own health insurance. You’ll know you have health insurance by receiving a summary of benefits for the policy. If you have not received this information, contact your insurance company or HR department to confirm your enrollment.

When does health insurance start at a new job?

It depends on the employer as to when their group health insurance will start for an employee. It can take up to 90 days before you become eligible to receive medical benefits, or it could be as early as the first day on the new job. In most cases you’ll have to opt in manually by filling out an application after you start the job. Not all jobs offer health insurance, so be sure to check with your employer to confirm your enrollment eligibility.

Hospital Indemnity Insurance

What is hospital indemnity insurance?

Hospital indemnity insurance is a type of health insurance that offers financial protection in the form of direct payments and/or reimbursements for common medical services including hospitalization and doctor benefits. With hospitalization indemnity insurance, there are no deductibles, networks and plans can include supplemental coverage for critical illnesses or accidents.

How does hospital indemnity insurance work?

Hospitalization insurance, also known as fixed indemnity insurance works by reimbursing or paying a fixed cash benefit directly to you or a designated healthcare provider every time you face a medical event covered by your policy without the need to meet deductibles or stay within a provider network of healthcare professionals.

Can you buy just hospitalization insurance?

Yes, hospital insurance plans are not tied to other health insurance plans and can be purchased separately; however, hospital indemnity insurance is not meant to replace your major medical insurance coverage but act as a supplement to your existing comprehensive health plan.

What does hospital confinement indemnity insurance cover?

Your hospitalization indemnity insurance coverage will depend on the policy you purchase. Most hospital insurance plans will cover hospital stay benefits paid by day and doctor visits benefits. Some plans can also include additional benefits such as telemedicine, pharmacy discounts and insurance advocacy services.

How much does hospital indemnity insurance cost?

Hospital indemnity insurance plans can be very affordable, plans on AgileHealthInsurance.com can start as low as $39.95/mo for a 30 year old; however, hospital confinement indemnity insurance costs will vary depending on the coverage benefits included in your policy.

Telemedicine

What is telemedicine?

Telemedicine is the diagnosis and treatment of medical conditions and the delivery of healthcare services done remotely by virtual doctors through the use of technology. It can be used for emergencies, preventive care, chronic disease management, post-hospitalization care and more. Telemedicine is not health insurance.

How does Telemedicine work?

Telemedicine allows healthcare professionals to treat patients through the use of computers, smartphones and tablets; online doctor appointments are normally done by phone or video calls. AgileHealthInsurance telemedicine services provided by Teladoc, give patients access to real online doctors 24 hours a day, 365 days a year.

Can telemedicine prescribe medication?

Yes, a telemedicine doctor can diagnose and prescribe medications for many conditions online; these include colds, allergies, asthma, skin issues and more. Generally, telemedicine virtual doctors do not issue prescriptions for addictive substances or non-therapeutic drugs, they may recommend in-person appointments for these.

Health Insurance Costs

How can I get cheap health insurance?

A high deductible plan will have the lowest monthly payment if you don’t have a lot of room in your budget for health insurance. The tradeoff is that you’ll have to pay more medical expenses out-of-pocket before meeting the deductible if you file a claim. Based on your income and household size, you may also be able to get government subsidies on an Affordable Care Act Plan. Health insurance becomes much cheaper with a subsidy, where you’ll pay no more than 2.08% - 9.86% of your household income each month for a mid-level plan. You may also qualify for no-cost to low-cost health insurance through Medicaid programs or the Children’s Health Insurance Program (CHIP).

How much does private insurance cost?

The cost for private insurance will vary depending on the following factors: age, location, tobacco use, and plan benefit levels. In 2019 the national average for an ACA health insurance plan is $477 without any subsidies, and $207 with subsidies.

What is the best cheap health insurance?

The best health insurance for you depends on a multitude of factors including your medical history, your current state of health, the state you live in, your income, and your lifestyle. The best cheap insurance will, at a minimum, cover accidents or illnesses that land you in the hospital. AgileHealthInsurance has many plans for under $100 a month that do not cover preexisting conditions, or you can consider the different ACA plans that do along with most medical events that arise from preexisting conditions or unforeseen medical events.

Why is health insurance so expensive?

Health insurance can be costly because it is reflective of the overall costs for hospital care, doctor’s office visits, prescription drug usage, and medical equipment needed. These costs can vary by state or region with some being more expensive than others.

Can I afford health insurance?

If your budget is minimal for health insurance, you can look into a high deductible plan which will have the lowest monthly payments. Both Obamacare plans and short term health insurance plans have high deductible options.

If you are comfortable with the streamlined services that short term health insurance provides, it can be an affordable choice in states where coverage can last six months or more.

Is health insurance tax deductible?

Health insurance premiums can be tax deductible in certain circumstances, but it will depend on your eligibility. If you’re self-employed you can deduct health insurance premiums which you pay for yourself. As an employee receiving health benefits, your total medical expenses must be more than 7.5% of your adjusted gross income (AGI) in order to get benefit from an itemized deduction. Also, you must be paying for health insurance using post-tax dollars. If you pay for health insurance using pre-tax dollars you won’t be eligible for a tax deduction.

What is a tax credit for health insurance?

Individuals and families with low income can qualify for a premium tax credit to help make health insurance more affordable. The savings can be applied to your monthly payments in an advanced premium tax credit (APTC), or all at once when you file your taxes. To receive the tax credit you must complete Form 8962, Premium Tax Credit (PTC) and attach it to your tax return.

How much does health insurance cost per month?

In data gathered from 2018, individual health insurance costs averaged to $440 per month, or $5,280 per year for a single person. For families it cost $1,169 per month on average, or $14,028 per year for health insurance.

If I apply for an insurance plan, am I obligated to buy?

You are not obligated to buy the insurance plan if you apply for it. You can always get a free quote to see how much it would cost before committing to it. The benefit levels and monthly premiums should determine whether or not you decide to purchase the policy.

Coverage

What are my health insurance options if I'm pregnant?

If you’re pregnant you can get health insurance through the Marketplace during Open Enrollment which begins on November 15th. As soon as your child is born you have a 60-day Special Enrollment Period to apply for ACA health insurance for your child. Maternity expenses are included as one of the 10 essential benefits in all Affordable Care Act approved plans. The Summary of Benefits provided with your insurance plan will list specific costs of coverage. If you are pregnant and struggling to pay for medical expenses, you can also qualify for health insurance through Medicaid.

Does health insurance cover abortions?

Paying for an abortion through health insurance is only possible in certain states, and through certain insurers. This information should be provided in the Explanation of Benefits which is included with your policy. Contact your insurance company if you’re unsure. Organizations such as Planned Parenthood can offer a discount rate if you have a low income, and there are other resources such as the Family Planning Benefit Program, community health centers, and Medicaid to help assist with abortion costs.

How long does it take to get health insurance? When does my coverage start?

If you buy Affordable Care Act health insurance during the Open Enrollment Period, your coverage will begin on January 1st of the following year. If you’re on an employer plan, it depends on the employer’s specific plan as to when your coverage will start. However, the ACA mandates that the coverage must be available within 90 days of your start date. If you apply outside of the Open Enrollment Period it depends on when your application is processed. If you obtain ACA health insurance, the payment is processed during the first fifteen days of the month, the coverage will begin on the first day of the month that follows. If the date of the enrollment is after the 15th, coverage will not begin until the first day of the second month. For example, if the payment for your new health insurance is not processed until June 17th, the coverage would not begin until August1st. If it is processed on June 15th or prior the policy would become effective on July 1st.

With short term health insurance, your coverage can begin as early as the day after your application is approved. There may be imposed wait times (often five days or less) for coverage for illnesses.

Can I change my health insurance plan mid year?

In most cases you can only make changes to your employer or ACA health insurance plan during the annual Open Enrollment Period. If you missed the Open Enrollment Period for an ACA plan and need to make a change, you may be able to qualify for a Special Enrollment Period. This can be granted if you lose job-based coverage, have a baby, get married, or certain other life changes. You can cancel your current health insurance plan at any time. For an employer plan you can make additions or deletions outside of the Open Enrollment Period for certain life events like births, divorces, or marriages.

What does health insurance cover?

There’s a wide variety of health insurance plans available, and each one has different benefits and coverage levels. It’s very important to have this information in writing, which should be provided by the health insurance company or its agent before signing up. When reviewing a plan’s coverage, know what is important to you. The Affordable Care Act requires that ACA plans provide ten minimum essential benefits, everything from maternity to mental health services.Medical expenses such as mental health and prescription drugs may not be covered under non-Affordable Care Act insurance plans.

Can you cancel health insurance at any time?

You can cancel your health insurance at any time by contacting your insurance company and requesting to terminate the policy. It doesn’t matter whether the plan is from your employer, the ACA health exchange, or short term health insurance.

How long can a child stay on parents health insurance?

Children can stay on their parents’ health insurance plan until they turn 26 years old. You can join your parents’ health insurance plan regardless of living at home or being married.

Can I drop my child from my health insurance?

You can add or drop a child from your health insurance plan by reaching out to your insurance company and making an adjustment to your policy. Depending on the insurer, you can complete the process online or over the phone. If you’ve purchased a plan through the government you may have to wait until the annual Open Enrollment Period.

Can I buy health insurance in another state?

The current law stipulates that you can only buy health insurance in the service area with your permanent address. Moving to another service area (e.g. another state) would require you to purchase a new health insurance plan in that new service area.

Does health insurance cover therapy?

ACA-compliant health insurance will cover mental health therapy, but the type of services and coverage will vary by state.

Do I need to be on the same plan as my spouse?

You do not need to be on the same health insurance plan as your spouse. You can purchase your own individual policy such as an Affordable Care Act plan available through the Marketplace or through a health insurance agency or broker, or enroll in an employer group plan.

How can I insure just my child?

It’s possible to get health insurance for your child on their own plan. You can purchase insurance for them during the Open Enrollment Period or if they qualify for a Special Enrollment Period. They may also be eligible for low-cost health coverage through the Children’s Health Insurance Program (CHIP). Contact the Medicaid office in your state to see if your child qualifies for CHIP benefits.

What does my health insurance cover?

The best way to see what your health insurance covers is to check the “Statement of Benefits” which is included in your policy. If you do not have this information contact your insurance company to request a copy. You can also ask them specific questions about what is and is not covered.

PPO & HMO

What does PPO mean in health insurance?

PPO is an abbreviation for “Preferred Provider Organization,” which is a popular type of health insurance network and plan. These networks allow you to visit any doctor or healthcare provider who is within the plan’s network at a discounted rate. You can still see providers outside of the network, although it will be more expensive because they may charge you at a higher rate. Under a PPO plan you’ll still have to pay a deductible, co-payment and coinsurance, as well as the monthly premium.

How does a PPO plan work?

In a PPO plan, you belong to a network of doctors and healthcare providers who offer services at a discounted rate. With a PPO plan you do not have to choose a primary doctor, and can visit any doctor or facility in the network to receive the lower rate. Like other health insurance plans, you will still have to cover your deductible, copay, and monthly premium. Once the deductible is met you’ll pay a certain amount for each visit as coinsurance. If you receive medical services from someone who is outside of the PPO network, you will have to pay a higher amount- although your insurance may still cover a certain percentage of the bill.

How does an HMO plan work?

HMO stands for “Health Maintenance Organization,” and the plans include a network of doctors and hospitals who offer lower rates for members. In an HMO plan you designate a primary doctor within the network who will make referrals to other specialists as needed.

What is the advantage of belonging to an HMO?

Many individuals and families prefer an HMO for health insurance because the plans do not require claim forms to see a doctor or during hospital stays. In-network care also usually costs less than out-of-network for a PPO.

What is the disadvantage of belonging to an HMO?

You must remain in-network to realize the cost savings. The premium that is paid is only enough to cover the costs of doctors within the network, otherwise you will be responsible for the entire amount.

What's the difference between HMO and PPO plans?

HMO and PPO plans are similar in that there’s a network of doctors and hospitals who offer services at a discounted rate. The difference is that in a PPO plan you do not designate a primary doctor, and you can still receive insurance benefits from doctors and specialists outside of the network. In an HMO plan, the insurance will not help cover medical expenses that are outside of the network.

Why would a person choose a PPO over an HMO?

PPO plans give participants the options to seek care from any in or out-of-network provider while HMO plans do not. PPO plans also usually have a higher monthly premium than HMOs. This can cost you a lot more money over the course of the year unless you're an individual who sees a lot of specialists.

HSA & FSA

How does an HSA work?

HSA stands for “Health Savings Account,” and are common with many employers who offer high deductible insurance plans, though non-employer plans may also be eligible. You pay into your HSA a certain amount which comes directly out of your paycheck on a pre-tax basis. This means that your health insurance payments will reduce your yearly tax liability. The money you (and your employer pay) into the HSA is known as “contributions” and goes into a savings account which you can use for medical expenses as they occur. When you turn 65 you can use your HSA money for non healthcare related expenses without incurring a penalty, but you will still be subject to income taxes on that money.

Is HSA a good idea?

Depending on your situation, they are probably the most tax-beneficial account available and not only that, for those who have good health and financial resources to pay for their healthcare out of pocket while they work, a health savings account or HSA is an effective way to prepare for an unexpected injury or illness.

How does an FSA work?

FSA is healthcare flexible spending account and can be chosen as part of an employer benefits package. Employees can contribute to their FSA up to a certain limit. The money in the FSA is deposited pre-tax into the account and used for eligible medical expenses for you, your spouse, and other dependents.

Dental Insurance

What is dental insurance?

Dental Insurance is a form of health insurance that covers part of the costs associated with dental care. Some of the services covered by a dental insurance plan include preventive care services like cleanings, routine exams and X-rays, basic services like fillings and root canals and major dental procedures like crowns, bridges and dentures.

How does dental insurance work?

Dental insurance is available as a standalone policy or as part of an existing health insurance policy. Depending on your dental plan, you may have deductibles, coinsurance, copayment and provider network restrictions. Your dental insurance policy benefits, limitations and exclusions details should clearly specify what procedures and services are covered and your expected out-of-pocket costs.

What are the different types of dental insurance?

There are different types of dental insurance:

  1. Preferred Provider Organization or PPO dental plans, which offer a network of preferred providers that lower your out of pocket costs. These plans usually have an annual maximum benefit, a deductible and require you to pay a percentage of the dental services, known as coinsurance.
  2. HMO dental plans, which require you to choose a dentist within your plan’s network and pay a flat fee, also known as a copayment for your dental services.
  3. Indemnity dental plans, also known as fee for service plans, which allow you to see any doctor and reimburse you for the covered dental services in your dental policy. Like PPO plans, these plans usually require you to pay coinsurance, have an annual maximum benefit and a deductible, and allow you to see any dentist of your choice.

What does dental insurance cover?

The dental care services covered by dental insurance plans are unique to each policy. However, most dental plans normally cover 100% of preventive care services such as cleanings and routine exams, 80% of basic procedures such as root canals and fillings, and 50% of major procedures such as implants and crowns.

What's the difference between dental insurance and dental discount plans?

Dental insurance works like health insurance. You pay a monthly premium, and there’s a deductible and co-pay. After you’ve met your deductible, the insurance company will pay up to a certain amount while you will be responsible for the remaining coinsurance. Certain preventive services, such as a yearly cleaning, are typically provided at no additional cost. There are different kinds of dental insurance plans including: dental HMO, dental PPO, and dental indemnity plans. On most dental insurance plans there is a maximum expense amount which will be covered which typically ranges from $1000-2000.

Dental discount plans are different from dental insurance plans. With a dental discount plan, you pay a yearly fee typically around $100-150, and there are no deductible or co-pays involved. Instead you receive a discounted price for dental services, which can range 10-60% from the regular price.

Is dental insurance worth it?

Here are some reasons why you should consider buying Dental Insurance:

  1. Dental Insurance can prevent serious dental problems: By having a dental insurance plan and regularly seeing your dentist, you can catch problems before they require extensive, costly procedures. Diagnostic and preventive dental services are usually affordable and sometimes completely covered by your dental plan.
  2. Dental Insurance can lower your dental care out of pocket costs: dental care services can be expensive, in fact, according to the U.S. Bureau of Labor Statistics, dental services costs increased by over 90% in 2019 compared to the year 2000. A dental insurance plan helps cover part of that cost.
  3. Dental Insurance can improve your overall health: Dental infections are known to cause or complicate existing conditions such as heart disease and diabetes. Taking care of your oral health can improve your overall health.

How can I get dental insurance?

The Affordable Care Act’s Health Insurance Marketplace offers dental coverage plans; however, they can only be purchased along with your health insurance plan during the yearly open enrollment period.

You can apply for standalone dental insurance outside the open enrollment period year-round through dental insurance carriers and licensed insurance brokers like AgileHealthInsurance.

Can you get dental insurance anytime?

You can get dental insurance at any time by applying for stand-alone dental coverage offered through dental insurance carriers and licensed brokers.

Can I add dental insurance after open enrollment?

You cannot add dental coverage to an ACA marketplace plan after open enrollment. You would have to wait until next year’s open enrollment period to find a marketplace plan that includes dental or buy a marketplace stand-alone dental plan. However, you can get dental insurance year-round through dental insurance carriers and licensed brokers.

Prescriptions

What’s the difference between prescription discount plans and prescription drug insurance?

Prescription discount plans are not the same as prescription drug insurance. With a prescription discount plan you pay monthly or yearly and are eligible to receive discounts from participating pharmacies and drug manufacturers. With prescription drug insurance it works like health insurance: you pay a deductible, copay and coinsurance, as well as a monthly premium to include it as a benefit on your plan. Some health insurance plans include prescription drug benefits while others do not, so if you want that coverage, you would need to purchase a stand-alone prescription plan.

Can I fill a prescription without insurance?

You can fill a prescription without insurance, but it may be more expensive. You can ask about generic versions of name brand drugs, and if there are any discounts available. You can also enroll in a prescription discount program to help with drug costs. Pharmaceutical companies also often offer programs to reduce your expenses if you enroll in one of their programs.

Do you need an insurance card to pick up prescription?

You do not need your insurance card to pick up a prescription as long as you have your member ID number and are up to date with paying your premium. The pharmacy will be able to verify your benefits by the information you provide them.

FAQ for Agile Customers

How to get health insurance?

There are two primary ways to get health insurance in the U.S.: buying it through a state- or federally-operated Affordable Care Act (aka ACA or Obamacare) online marketplace or through a private company like (Cigna, Humana, etc.).

Typically, most Americans apply or reapply for health insurance during the Open Enrollment Period, which usually runs for a number of weeks at the end of the calendar year and goes into effect on January 1 of the following year. If you need health insurance in 2020, the time to do so runs from November 1 through December 15, 2019.

There are a couple exceptions to this rule— the first of which is Short Term Health Insurance. This type of health insurance is major medical insurance that provides coverage for a predefined period of time.

Short Term Health Insurance plans are known for their inexpensive and affordable premiums, some of which may cost less than half the price of an entry-level Obamacare plan. These plans may be worth considering if you’re in good health and don’t need the comprehensiveness of coverage offered by an ACA-compliant plan.

However, applicants with pre-existing conditions typically do not qualify for this type of coverage. These plans are available year-round and offer the majority, but not all of the 12 essential health benefits that ACA marketplace plans are required to offer.

Some of us simply don’t need some of these benefits like maternity and newborn care but that being said, it’s incredibly important that you read and understand every benefit offered by your health insurance regardless of the policy you eventually purchase.

The second exception, which allows you to purchase any health insurance policy outside of Open Enrollment, is if you qualify for a Special Enrollment Period (SEP).

Certain life events such as losing health coverage, getting married, or having a baby will qualify you for a Special Enrollment Period of 60 days. During this time, you may enroll for an ACA-compliant plan, as well as Short Term Health Insurance or Health Benefit Insurance right here on agilehealthinsurance.com.

What does short term health insurance cover?

Short-term health insurance covers doctor visits, hospitalizations, emergency care, lab tests, x-rays, and other common medical needs.

Is short-term health insurance Obamacare?

No. Short Term Health Insurance is a streamlined insurance plan that’s different from Obamacare in 3 key ways:

  1. Short Term Health Insurance is advantageous for some people because the monthly premiums are generally less expensive than those of an ACA plan or an individual plan from a private insurer.
  2. Short term plans are available for purchase year-round and can now be bought in increments of up to 364 days. Some carriers even offer plans that are renewable for up to 36 months depending on state regulations.
  3. Short-term health insurance also involves an application. Depending on your health status, your application may be declined or your pre-existing condition may be excluded. Obamacare guarantees that all applicants and their pre-existing conditions will be covered.

When can I apply for short-term health insurance?

You can apply at any time. There is no fixed open enrollment period. On agilehealthinsurance.com, you can submit an application in minutes. If approved, your insurance policy can become active within 24 hours of submission.

Can I renew my Short Term Health Insurance policy?

Since the laws regarding Short Term Health Insurance are largely based on state laws, it depends on where you live. Some states allow you to reapply and maintain your same coverage for up to 36 months, while others only allow you to have a Short Term policy for up to 364 days. This is not the same as renewing a plan.

To reapply, you must submit a new application with your up-to-date health information and the carrier will determine whether to underwrite a new policy for you. There is a chance that your application may be declined if you’ve contracted a pre-existing condition, but if not, your reapplication can be processed within 24 hours.

Call agilehealthinsurance.com at (800) 314-5594 to learn more about reapplying for Short Term health Insurance.

What about the Obamacare tax?

The Obamacare tax, formally known as the Shared Responsibility Tax applies to individuals who have gone without an Affordable Care Act plan (such as Obamacare or employer-based plans) for three months or more within a calendar year.

While this tax will no longer be effective as of January 1, 2019, you are still responsible for paying it if you gone without coverage for three or more months in the tax year 2018.The amount you’re required to pay each year is either 2.5% of your household income in excess of the tax return filing threshold or a flat dollar amount ($695 per adult, $347.50 per child or $2,085 per family), whichever amount is greater.

To learn more about the Shared Responsibility tax, head over to IRS.gov.

If you have a term health plan for a period of less than three consecutive months in 2018, and ACA-compliant coverage for the remainder of the year, you may not be subject to the tax.

What about cancelling a plan?

You can cancel your plan and receive a full refund within the first ten days of the effective date of your plan. For cancellation beyond this ten-day window, you simply email or call us with your reason for cancelling. We try to handle cancellation requests within 24 business hours of receiving them.

What about pre-existing conditions?

Typically, short term health insurance costs less than Obamacare because it doesn’t cover pre-existing conditions. Also, there is an application with health questions that will determine your eligibility for the plan you’re interested in.

What conditions on the application will make me ineligible?

If you have been diagnosed, treated, or taken medication for any of the following conditions within the last 5 years, Short Term Health Insurance cannot be issued: Cancer or tumor, stroke, heart disease, including heart attack, chest pain or a history of heart surgery, COPD (chronic obstructive pulmonary disease) or emphysema, Crohn's disease, liver disorder, degenerative disc disease, rheumatoid arthritis, kidney disorder, diabetes, degenerative joint disease of the knee, alcohol abuse or chemical dependency, or any neurological disorder, HIV or AIDS, or if you are now pregnant or in the process of adoption.

If you are looking for insurance to cover your pre-existing conditions, we can refer you to an agent who can help you find a health insurance plan to cover these conditions:

  • For ACA/Obamacare Plans: 888-475-8043
  • For Medicare Plans: 855-382-4440

Can I add someone to my policy?

Currently, you may only add a newborn child up to 30 days old to any policy you’ve purchased for yourself through agilehealthinsurance.com.

Do you cover prescriptions?

Besides Unified Health One (which cover prescription benefits), all plans purchased on agilehealthinsurance.com include a discount card that gives you up to 47% depending on your prescription.

How can I change my billing date?

There is no way to change billing date however you do have a 30-day grace period from your effective date to pay your monthly premium.

Why have I been charged twice?

You’ve likely been charged twice because when you reapplied for another policy, the premium for that policy is charged to your payment method on the same day. It’s possible that you’re seeing a charge for your currently active policy as well as the new policy.

How do I sign into my portal?

After successfully applying for a policy, you were sent a welcome email that contains a login link along with a unique username and password you need to access your Customer Portal. If you can’t find this email or never received it, please contact us at (800) 314-5594 or support@agilehealthinsurance.com.

What does my policy cover?

This depends on the benefits included with the policy you’ve purchased. To view your benefits, log in to your Customer Portal, select “My Plan”, then “Insurance Certificate” or “Certificate” to view a document that includes your plan’s schedule of benefits.

How can I find in-network providers?

To find a provider in your network simply log in to your Customer Portal, select “Customer Links”, then click the first link (usually includes the word “PPO” on that page.

Where do I send claims?

Claims can be sent to your plan’s claims administrator. Contact information for your claims administrator can be found in your plan’s welcome email or by logging in to your Customer Portal, navigating to the “Contact” tab and scrolling down to the “Claims Administrator” section.

Why have I been billed x amount for my visit?

This can be due to a number of factors. Contact us at the phone number or email address below and one of our Customer Support Specialists will be happy to answer your question.

Contact AgileHealthInsurance!

Phone: 800-314-5594

Agile Health Insurance Customer Service Department has language assistance services.

Email: support@agilehealthinsurance.com

Address: 218 E. Bears Ave, Suite 325, Tampa, FL 33613

Fax: 877-376-5832

Hours of Operation: Monday - Friday 8:30 a.m. to 7 p.m. EST