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Common Health Insurance Questions and Answers

A young Caucasian couple reviewing insurance policies and depicting common health insurance questions.

“I need health insurance, but where do I start?” There are plenty of first time buyers that have health insurance questions and it’s understandable. Many new buyers wonder about the Affordable Care Act a.k.a. Obamacare, where to find health insurance, what health insurance plans are available, and many other issues about healthcare coverage in the United States. Here are some health insurance facts, information, and answers to the most common healthcare questions.

Navigating the Healthcare System in the US

Do I Need Health Insurance?

Health insurance isn’t mandatory at a federal level since 2019. Before this time, people were required to have a health plan for themselves and their family members through ACA or a private insurer, and unless they had an exemption, it would generate a tax penalty. 

That being said, while there won’t be fees that need to be paid, having insurance could save you money in the long run if you experience an accident, or get sick.

What Health Insurance Coverage Do I Need?

Your health insurance needs depend on your health condition, lifestyle, and preferences. Generally, we recommend choosing a comprehensive plan covering doctor visits, hospital stays, prescriptions, and preventive care for overall well-being.

What If I Don’t Get Health Insurance?

According to, as of 2023, the fee for not having health insurance ended in 2018, which means that paying a tax penalty is no longer required, and you don’t need an exemption for it. However, if you are above 30, and want catastrophic health coverage, you will need to apply for one.

Other states that have their own exemptions are California, Maryland, and the District of Columbia.

Where Can I Get Health Insurance?

Your employer may offer you health insurance as a benefit in your job or you can purchase individual health insurance outside of the marketplace. However, if those aren’t valid options, you can purchase insurance through the ACA during Open Enrollment.

What Health Insurance Plans Types Are Available in the US?

  • Health Maintenance Organization (HMO) – In HMO plans you choose a primary care physician (PCP) within the plan’s network, and they coordinate all your health care needs. If you need to see a specialist, your PCP will refer you. HMOs typically require referrals for specialist visits and focus on preventive care.
  • Preferred Provider Organization (PPO) – PPO plans offer a bit more freedom. You can see any healthcare professional, but your out-of-pocket costs are lower if you stick to the network. PPOs don’t require referrals to see specialists, giving you more control over your healthcare choices.
  • Point of Service (POS) – POS plans mix some elements of PPOs and HMOs. You pick a primary care physician within the network and need referrals to see specialists. However, you can venture outside the network, albeit with higher costs. POS plans provide flexibility with a balance between cost and choice.
  • Exclusive Provider Organization (EPO) – EPO plans are strict about staying in-network. You must use healthcare providers and hospitals within the plan’s network, except in emergencies. EPOs typically offer lower premiums and out-of-pocket costs, making them a budget-friendly choice if you’re willing to stay within the network.

Health insurance plans are often categorized into different metal levels – Bronze, Silver, Gold, and Platinum. These levels indicate the balance between premiums and out-of-pocket costs. Bronze plans usually have lower premiums but higher deductibles, while Platinum plans have higher premiums but lower out-of-pocket costs. You can choose a level based on your anticipated healthcare needs and budget.

What About Insurance Coverage for Out-Of-State Treatments?

While urgent care is usually covered, non-emergency  or routine care might require pre-authorization. Verify the details with your insurer, considering state-specific rules.

Are Mental Health Services Covered by My Insurance?

Most plans cover mental and behavioral health services, but extent and providers vary. Some states have laws ensuring mental health coverage matches physical health. Review your policy or contact your insurer for detailed information on mental health coverage.

What Happens to My Insurance If I Move to Another State?

Moving can affect your insurance. You might need to update your information within a specific time frame or switch plans if your current provider doesn’t operate in your new state, or the newest location has different requirements/regulations that aren’t covered in your actual policy.

Open Enrollment Healthcare Questions

Navigating open enrollment requires understanding your options and deadlines. Be proactive, stay informed about changes, and ensure you have the coverage you need for the coming year.

What is Open Enrollment?

Open Enrollment is the annual period where you can apply and get health insurance quotes through Covered California and the Affordable Care Act. As of this writing, Open Enrollment starts on November 1st, 2023 and ends on January 15, 2024 in California. The time period in your state may be different.

Can I Enroll In a Health Plan Outside of the Open Enrollment Period?

Certain life events, like marriage, having a child, or losing other health coverage, trigger special ACA coverage enrollment periods. You have 60 days before or after the event for a special enrollment period in a new plan. Contact an insurance agent or Covered California representative to see if you qualify.

What Happens if I Miss the Open Enrollment Deadline?

Missing the open enrollment deadline when you already have insurance coverage, means that it may continue automatically for the next year without being able to make changes to your current plan.

If, on the other hand, you don’t currently have health coverage you may have to wait until the next enrollment period to get it. However, you might qualify for Medicaid or the Children’s Health Insurance Program (CHIP) even outside of the open enrollment period, as you can apply to those anytime of the year.

Can I Change My Plan After the Open Enrollment Period?

In most cases, you cannot change your health plan after the open enrollment period unless you experience a qualifying life event. It’s essential to choose a plan that fits your needs during open enrollment.

Can I Enroll In Medicaid or CHIP During Open Enrollment?

You can apply for Medicaid or CHIP at any time of the year, as there is no limited enrollment period for these programs. Check your state’s Medicaid office for application details and eligibility criteria.

Can I Be on Medicare and ACA at the Same Time?

You could, but without the advance payments of premium tax credits and savings on out-of-pocket expenses that contribute to paying your share of the Marketplace premium and covered services, this means you would need to pay for them full-price.

Chronic Illness or Pre Existing Conditions Healthcare Questions 

What is the waiting period for pre-existing conditions?

Thanks to the Affordable Care Act (ACA), pre-existing conditions cannot be denied coverage. There are no waiting periods for such conditions, ensuring you get the care you need immediately. 

However, some state-specific plans might have exceptions, especially short-term or limited benefit plans. You would also like to keep in mind that the ACA allows employer-sponsored health plans to have waiting periods of up to three months before employee coverage begins. Consequently, a new employee might have to work for several months before becoming eligible for coverage under the employer’s plan.

Are There Specific Plans Designed for Individuals with Chronic Illnesses?

Of course! Many health insurance companies offer specialized plans tailored for chronic conditions. These plans often cover regular check-ups, medications, and treatments crucial for managing your health effectively.

Can Preexisting Conditions Affect My Premium Rates or Coverage Limits?

Not anymore. Thanks to the Affordable Care Act (ACA), insurance companies can’t hike your premiums or limit your coverage due to preexisting conditions. This ensures fair access to essential healthcare services.

How to Get the Cheapest Healthcare Insurance

What Factors Influence the Cost of Health Insurance Premiums?

Your premium depends on factors like age, location, category of the plan, if you smoke, or if you are covering any dependents. Generally, older individuals pay higher premiums, and your location can impact costs due to local healthcare prices and regulations.

 Is There a Way to Estimate My Healthcare Insurance Costs Online?

Absolutely! You can request a quote with insurance companies like Freeway Insurance that can help you estimate your healthcare costs considering your needs, preferences, and budget, and providing a good estimate of what you might pay for health insurance.

How Can I Find the Right Health Insurance Plan for Me?

Before committing to a health plan, do your research. Figure out what kind of coverage would fit your needs and what will fit within your budget. Take into consideration any recurring prescriptions you may have, if you have a trusted doctor that you want to have in your network, or any specialists you require. 

Covered California officials and third-party insurance agents such as the ones at Freeway Insurance can also help you choose a health plan that fits your needs out of the offers you are given.

What Should I Know About Out-Of-Pocket Healthcare Costs?

Out-of-pocket costs include deductibles, copayments, and coinsurance. Usually, plans with higher premiums often have lower out-of-pocket expenses.

How Can I Compare Different Health Insurance Plans to Find the Most Affordable One?

When comparing a health insurance plan we recommend you take a look at coverage, network size, and costs. Consider your regular healthcare needs and choose a plan that covers your requirements without unnecessary extras.

How Can I Find the Right Health Insurance Company?

Research is key to finding the best health insurance company for your needs. Read customer reviews, check the company’s reputation, and assess their customer service. A reliable company ensures a smoother experience when dealing with claims and healthcare needs.

How Can I Save Money on Health Insurance?

There are many different ways you could potentially save extra money on health coverage. You may qualify for federal subsidy or pick a plan that has a higher deductible. You could also look into investing more money into a health savings account in exchange for a lower rate. If your coverage needs are more basic, you won’t need to pay a higher cost for wider coverage. You can explore more options, see if you qualify for certain benefits/discounts, and find other ways to save by contacting a Covered California rep or an insurance agent.

You can sign up for a quality ACA plan and other health insurance offers through Freeway Insurance. Freeway collects insurance quotes from some of the top providers in the nation to present to you the lowest-priced insurance possible. Get a free health insurance quote online or call us today at (800) 777-5620 to get quality protection, avoid the tax penalty, and save money.

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