Health Insurance FAQs

What’s the difference between an HMO, PPO, and EPO plan?

HMO (Health Maintenance Organization): Requires in-network doctors and referrals.

PPO (Preferred Provider Organization): More flexibility—no referrals and includes out-of-network coverage.

EPO (Exclusive Provider Organization): In-network only (like HMO) but no referrals needed.

How do I know if my doctor is in-network?
Check the provider directory on your insurance company’s website or ask your agent directly.

What does my deductible mean, and when do I pay it?
It’s the amount you pay out-of-pocket before your insurance begins covering services.

What’s the difference between a premium, copay, and coinsurance?

Premium: Your monthly payment.

Copay: A fixed fee for a visit or service.

Coinsurance: A percentage you pay after meeting your deductible.

How can I lower my monthly premium?
Consider a higher deductible plan, explore subsidy eligibility, or adjust your coverage levels.

Do I qualify for subsidies or tax credits through the Marketplace?
Yes, if your income falls within certain limits. Your agent can help you calculate eligibility.

What if I missed open enrollment—can I still get coverage?
You may qualify for a Special Enrollment Period due to life events like moving, losing coverage, or getting married.

What’s the difference between Marketplace plans and private plans?
Marketplace plans can include income-based subsidies, while private plans may offer broader coverage or additional options.

Can I get coverage for just my kids?
Yes, many health plans allow you to enroll children separately from adults.

What’s covered under preventive care?
Preventive care includes screenings, wellness checkups, immunizations, and services that help detect or prevent illness early.