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 …

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 …

Are all hospitals supposed to accept any or all insurance?

In the past, each hospital has been able to select which insurance plans it will accept. This could mean that if you got sick or injured while traveling, for example, and you had to visit an emergency room that you may have had to pay entirely out of pocket for care provided at that distant hospital if they “didn’t take your insurance.”

This will no longer happen to a large degree. All Marketplace plans will offer the same set of …

How do I take on a new cost for health insurance when I can barely pay my bills now?

A spending plan is just exactly that, a plan for how you will spend all the dollars your earn and those given to you (including, hopefully, directing some to savings). To make a change in your spending plan such as adding in health insurance costs or taking on a new car payment, it helps to be as inclusive as possible when calculating all of your monthly expenses. In other words, don’t write in only the premium cost, but include some …

How are health insurance and car insurance similar and different?

Car (automobile) insurance is similar to health insurance in a very important way: both types of policies provide protection against financial losses. 

Automobile and health insurance both help policyholders cover large costs that could financially devastate the individual or the family, like those experienced in unexpected car accidents or major medical procedures such as surgery, chemotherapy, expensive tests, or hospital stays. 

Health insurance generally provides a wider range of benefits than car insurance. Car insurance, for example, will not pay …

Is there anyone who can help me determine my best health insurance option?

Each state will have consumer helpers available to assist individuals with health insurance decision-making. Find these helpers at Healthcare.gov the official site which provides accurate information to guide you through health insurance decision-making, and which also connects you to the Health Insurance Marketplace in your state.

Beware of commercial insurance industry professionals offering “free advice” or “assistance;” their efforts may be just a ploy to get you to buy their company’s policy regardless of other options that may meet …