Health Insurance
Knowledge Center

You find an insurance plan that you like. You pay a monthly premium to the health insurance carrier so that they will cover any potential medical needs you will have. The carrier holds your money until you make a claim (i.e. go to the doctor, the emergency room, get a prescription), and then they will help pay for the service you received. What they pay you depends on your deductible, co-pay or your co-insurance.

Here is a breakdown on why insurance is so costly:

• Health care is expensive. Hospital stays, surgeries, medical tests, prescription drugs….all of these things cost a ton of money. And the costs keep going up, unfortunately.
• Insurance companies have to be solvent, meaning they need enough money in the bank to be able to financially cover every person who has purchased a plan through their company.
• Insurance companies have to give advanced payment for your preventative care. A qualified health plan has to 100% cover your preventative care and wellness checks.
• Health insurance providers have to share the cost of preexisting conditions. Due to the Affordable Care Act ruling, no one can be turned away from getting health insurance due to a pre-existing condition. This means the cost is distributed to everyone.
• Insurance companies have to pay staff, agents and brokers. (And unfortunately, like any business, there are often inefficiencies due to overstaffing, business processes, etc.)

Health insurance brokers are FREE (at least for the person buying the plan, which is YOU).

Here is how a broker works:

You contact a broker and tell them what you’re looking for in a health insurance plan. They do some research and give you a couple of plan options. You select the option you want and purchase the plan through the broker (again, this is FREE to you). This is when the relationship begins between you and the health insurance carrier you just bought a plan with. Essentially a broker is like a middleman (or woman!), and the carrier pays the broker a commission for making this connection.

Brokers are FREE to you and they’re really helpful: they save you the time and energy of searching for a health insurance plan.

Open Enrollment is the yearly period when you can buy individual health insurance. The Open Enrollment Period for most states is November 1st – December 15th. If you enroll by December 15th, your coverage will begin January 1st of the following year.

If you miss open enrollment, you’re stuck without insurance for another year.


…Unless you qualify for a qualifying event outside of open enrollment.

Since Jan. 1, 2019, the tax penalty has been repealed. If you don’t have major medical health insurance for the 2019 coverage year, you won’t be penalized. However, there will still be a tax penalty for no health insurance in 2019. If you are uninsured this year, you could be penalized when you file your 2019 taxes in 2020, unless you’re eligible for an exemption.

Otherwise known as “Obamacare”, this is the healthcare reform act President Obama signed into law on March of 2010.

It’s essentially government assistance. Your tax credit is based on the income estimate and household information you put on your Marketplace application.

You can use all, some, or none of your premium tax credit in advance to lower your monthly premium.

• If you use more advance payments of the tax credit than you qualify for based on your final yearly income, you must repay the difference when you file your federal income tax return.
• If you use less premium tax credit than you qualify for, you’ll get the difference as a refundable credit when you file your taxes.

You can buy health insurance through other sources, but the only way to get a premium tax credit is through the Health Insurance Marketplace.

You may notice that health insurance plans come in five different types: catastrophe, bronze, silver, gold, and platinum. The metallic tier system was created to give consumers a quick and easy way to understand what you can expect from different plans.

• Catastrophe: A catastrophe plan is available to applicants under the age of 30, and it only covers “catastrophic” medical needs such as a car accident or cancer. In other words, you’ll have a low monthly cost, but you’ll be paying out of pocket for most of your basic medical services. This plan is good if you just want to cover worst-case scenarios.
• Bronze: A bronze plan will cover 60% of your medical needs and expenses. Usually your monthly cost will be low, but you will have to cover the other 40% of your medical bills. This plan is good if you don’t plan on going to the doctor often.
• Silver: A silver plan will cover 70% of your medical needs and expenses. Your monthly cost will be somewhere between low and high, but you’ll only have to pay 30% of your medical bills. This is your middle-of-the-road plan; it’s good if you go to the doctor a handful of times a year.
• Gold: A gold plan will cover 80% of your medical needs and expenses. Because gold covers a good chunk of your bills, your monthly payment will probably be on the higher side. If you plan on going to the doctor a lot, this will be an inexpensive plan in the long run.
• Platinum: A platinum plan is the Cadillac of insurance plans. It will cover 90% of your medical needs and expenses. Because of this, your monthly payment will be high; however, this is a smart choice is you have chronic medical needs, like cancer or heart disease.

A primary care physician, or PCP, is a doctor that you will designate on your insurance form to be your first point of call when you have a medical need. However, this doesn’t pertain to medical emergencies.

Not all health insurance plans require you to designate a primary care physician. You do not have to select a PCP if you have a PPO, EPO or POS plan. If you have an HMO plan, you will need to select a PCP, otherwise the insurance carrier will select one for you.

In-network: This means your doctors or services are covered by your insurance plan.

Out-of-network: This means your doctors or services are NOT covered by your insurance plan.

Brand name drugs: A prescription drug, sold by a company, that is protected by a patent.

Generic drugs: A prescription drug that has the same ingredients as a brand name drug. Typically these pills cost less than brand name drugs and are deemed safe by the FDA.

A co-pay is a fixed dollar amount (for example, $20), set by your insurance plan, that you pay for healthcare costs, including doctors visits and prescriptions. This amount can vary depending on your insurance plan. Your plan may also have different amounts for different kinds of health expenses, like primary care visits, specialist care visits or brand or generic prescriptions.

Example: Many insurance plans have a $25 copay for primary healthcare provider visits, which means you pay $25 for your doctor’s appointment.

This is how much you pay after you’ve reached your deductible when your carrier doesn’t cover the full cost of service, which is typically around 30% of the cost. Co-pays are different from coinsurance in that coinsurance is a fixed percentage that you’ll have to pay for medical services (ex. 20% you/ 80% insurance provider).

This is the amount you will pay for medical costs subject to the deductible until your carrier picks up the rest of the tab. Deductibles are different for each plan. Example: You have a silver plan with a $4,000 deductible; this means your insurance won’t pay for certain services until you’ve paid the $4,000 deductible.

This is the MOST you’ll end up paying for your medical bills in a single year.

For example, say you decided that you no longer want to be an investment banker and you want to fulfill your lifelong dream of being a rodeo star. Your rodeo career is going well until your horse bucks you and steps on both of your ankles. You have to get emergency surgery and stay at the hospital for a week. Your medical bill ends up being $45,000, but don’t let that end your cowboy dreams. You won’t have to pay the full $45,000. The most you will pay is your out-of-pocket max, which could range anywhere from $3,000 to $6,850. That includes your deductible amount AND any co-insurance amount you have.

The only time this may not be applicable is if you receive medical service out of your plan network.

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Healthshares are not health insurance. Healthshares are organizations that facilitate sharing of health care costs among individual members, who have common ethical or religious beliefs.

There are no contracts with healthshare programs and you have the right to terminate coverage at any time.

Unlike Affordable Care Act plans that require you to enroll in short annual enrollment periods, you can enroll in a healthshare plan at any time during the year.

Write the answer to the question here. This way, your visitors can easily pick the questions that matter to them, without being distracted by loads of text from the FAQ.

The text in this landing page gives you a lot of help in creating good copy. And don't worry about it too much. The only way to get better at copywriting is to write more copy. So, get writing.

Write the answer to the question here. This way, your visitors can easily pick the questions that matter to them, without being distracted by loads of text from the FAQ.

The text in this landing page gives you a lot of help in creating good copy. And don't worry about it too much. The only way to get better at copywriting is to write more copy. So, get writing.