Health Insurance FAQs

September 6, 2023

Feeling overwhelmed by health insurance options? Don’t worry, we’ve got you covered. 

Navigating the right health insurance plan can be a challenging undertaking, but understanding your options and asking the right questions is key. 

To make your decision easier, we’ve compiled a list of ten essential questions to consider when selecting a health insurance plan. These questions will help you evaluate the different plan details and find the perfect fit for you, your family, your health, and your budget.

Armed with this knowledge, you can confidently compare health plans and get closer to finding the perfect option that meets your needs. Whether you’re new to choosing a plan or considering switching, these questions will guide you in the right direction. 


General Questions

1. How do I choose the best health insurance plan? 

Choosing the right health insurance plan is a crucial decision with far-reaching effects on your family, finances, and overall well-being.

 So, it’s essential to take your time and carefully compare multiple plans. Look for one that provides coverage for the specific healthcare needs you’re most likely to have while still being affordable for you. 

To make the search as seamless as possible, we’ve compiled common health insurance mistakes to avoid as you explore different options. 


2. What and when is open enrollment?

Open enrollment is the time during which you can sign up for new health insurance or change your existing plan. It’s an important time to make sure you have the coverage you need. For most plans, this window to modify your insurance or sign up occurs in the fall. However, certain plans such as Medicaid provide open enrollment all year long. 

Additionally, you have the opportunity to enroll in new or different health insurance anytime you experience a qualifying life event, such as getting married or changing jobs. Stay informed and take advantage of these enrollment periods to secure the right health insurance for you and your family. 


3. What is the difference between a premium, deductible, copayment, and coinsurance? 

A premium is the amount you pay monthly or annually to maintain your health insurance coverage. A deductible is the amount you must pay out of pocket for covered services before your insurance starts to contribute. Copayments are fixed amounts you pay for specific services or medications at the time of service. Coinsurance refers to the percentage of costs you share with the insurance company after meeting your deductible. 


4. How do I file a claim with my insurance company? 

When you visit a healthcare provider, you give them your insurance details and they submit a claim to your insurance company. The provider gets paid by the insurance company, and you may receive an Explanation of Benefits (EOB) that explains what charges are covered and not covered. 


5. What is a network, and why does it matter?

In the world of healthcare, a network is a group of doctors, hospitals, and other healthcare providers who have partnered with an insurance company. These providers have agreed to provide services at rates that have been negotiated with the insurance company. 

However, if you choose to go out of network, you may face higher costs or limited coverage, depending on your specific insurance plan. 


6. What is an out-of- pocket maximum?

The out-of-pocket maximum is the highest amount you will have to pay for services covered by your insurance policy in a year. Once you reach this limit, your insurance company will usually cover 100% of the costs for covered services, excluding premiums. 


Special Circumstances 

1. How do I get health insurance if I’m unemployed? 

Losing your job is tough, especially when it also means losing your health insurance. But don’t worry, there are options available for getting coverage if you’re unemployed. You might be eligible for government programs like COBRA or Medicaid, or you could consider enrolling in a marketplace or short-term health insurance plan. 


2. How do I get health insurance if I’m self-employed? 

It’s crucial to research and compare different options based on your specific needs, budget, and location. There are both private and government health care options for self-employed individuals. 

Options include but are not limited to: 

  • Health insurance marketplace 
  • Professional associations 
  • Spouse’s plan 
  • COBRA continuation coverage
  • Medicaid 
  • Private insurance providers 
  • Health Savings Account


3. Can I use my health insurance plan for pre-existing conditions? 

Many health insurance plans now cover pre-existing conditions. However, it’s crucial to know that the coverage can vary from plan to plan. Some plans may require waiting periods before providing coverage for pre-existing conditions, while others may offer immediate coverage. To make informed decisions about your health insurance, it’s essential to review the policy details for a full understanding of how pre-existing conditions are covered. 


Final Thoughts 

Understanding health insurance is crucial for navigating the complex world of healthcare and protecting yourself from unexpected medical expenses. Whether you’re self employed, unemployed, or have other special circumstances, there are various avenues to explore when seeking health insurance coverage. 

From government programs like Medicaid to private insurance plans and marketplace exchange, it’s important to research and compare options that suit your needs and budget. Additionally, being familiar with key insurance terms can help you make informed decisions. 

It’s important to keep in mind that consulting with insurance professionals or healthcare experts is recommended for personalized advice based on your specific situation. By obtaining the right health insurance coverage, you can gain peace of mind and access to necessary medical care when you need it most.