Health Insurance FAQs

The Health Insurance Literacy ASK group provides answers to your questions about the Affordable Care Act to help you make smart health insurance choices and to plan your personal finances.

Here is a collection of the most common questions. If you can’t find the answer to your question among the list, you can search for additional information using the search box at the top of the page or submit your own personal question to our Ask an Expert Feature. …

What happens if even the bronze plan under the Affordable Care Act (ACA) costs too much?

The Affordable Care Act mandates that most people are insured either through their place of employment or purchasing a policy on their own. Remember, beginning in October 2013 there will be options in every state for purchasing insurance through a state-wide Marketplace.

There are exemptions from that mandate for several reasons including financial hardship, which is an official definition based on income and family size. The good news is that, depending upon your income level, you may qualify for

Do children fall off my insurance policy on the day of their 26th birthday? How do they avoid a lapse in coverage?

Under the Affordable Care Act, children and step children can stay on their parent’s insurance policies until their 26th birthday, provided the parent’s plan allows dependent coverage. Retiree insurance plans, for example, are not required to extend coverage to dependents. Children can be covered by the parent’s insurance plans even if they are married, do not live with the parent or are not financially dependent on the parent. They can also be covered even if they are eligible to …

Are all pre-existing conditions allowed?

Yes, all pre-existing conditions are allowed and can no longer be used to bar an individual from obtaining health insurance coverage. This provision of health care reform and guarantee of coverage went into effect for children in 2010 and will apply to adults in 2014.  Premiums will not be allowed to use pre-existing conditions as a factor for establishing rates.

The cost of coverage can be adjusted using only these four factors:

1) whether the policy covers an individual or …

What is the difference between bronze, silver, gold and platinum plans?

In order to be included in the Health Insurance Marketplace, each insurance company can offer four different types of “qualified” health insurance plans– Bronze, Silver, Gold, and Platinum.

A Bronze Plan will cover 60% of health care costs with the consumer responsible for paying 40%. For Silver plans insurance companies pay 70% of costs and the consumer pays 30%. For Gold Plans, the split is 80%-20% and for Platinum the split is 90%-10%.  In general, the more the company …

Can grandchildren being taken care of by grandparents be on our insurance until age 26 and what if we go on Medicare?

Grandparent

Grandparent

If you are the legal guardian or foster parent, your grandchildren can be added to a healthcare plan you purchase on your own through your employer until they reach the age of 26. If you are not the legal guardian, they will not be covered in your individual or employer plans and you will have to look at other options.

Medicare is and will remain as individual health insurance only for those 65 and over. If you are on …

What is the difference between a premium, a co-pay and and out-of-pocket expense?

Health Insurance Plan costs can be broken into two categories: cost of having the plan and costs of using the plan. In order to purchase and continue to have health insurance coverage, you have to pay a premium. The premium is paid on a regular basis such as a certain amount monthly, quarterly or yearly. It is typical that when purchased through your employer, the plan premium is deducted from each paycheck. Basically, the premium buys you the health …

What do EPO, PPO and POS mean?

In the world of health insurance, there are separate and distinct types of insurance plans. In general, the three types of plans are Exclusive Provider (EPO) network, Preferred Provider (PPO) network, and Point of Service (POS) network. These plans differ by cost and types of coverage provided.

The Exclusive Provider network or EPO is a managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency). This …