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FAQ

We are here to answer your questions, every step of the way.

  • Does the company you work for offer health insurance?
    If not, then you may purchase your coverage through the Marketplace and possibly qualify for a lower premium.
  • Will it cover members of my family as well as myself?
    That depends on the employer plan design.
  • How much of the premium costs will I have to pay?  How much will my employer pay?
    That is determined by the employer. Generally, the minimum amount the employer must contribute for the employee cost is 50% of the premium.
  • Can I choose different levels of coverage?
    Determined by your individual employeer.
  • If my employer doesn’t offer the benefits I need, where can I get help?"
    Work with a licensed agent to meet your benefits you need.
  • What are the advantages of giving your employees benefits?
    Employee benefits provide your employees with resources to remain healthy and productive. Recruit and retain employees. Creates a positive culture and morale of caring. Tax advantages – for both you and your employees. Reduce turnover
  • Am I required to provide my employees with health insurance?
    The Patient Protection and Affordable Care Act (PPACA) requires an employer with 50 or more employees to either offer employees health insurance or pay a fee.
  • How many employees does it take to have a group health plan?
    If you are the only one who works at your company, you’re actually a sole proprietor and don’t qualify for small business group health insurance (even if you take a salary and consider yourself an employee). If you are sole proprietor, you will need to look into options for individual/family health insurance. This is also the case if you and your spouse are the only employees of the company. However, you may enroll your spouse as your dependent if you qualify for small business group health insurance because you have at least one other unrelated, full-time employee who participates in the plan.
  • How much of the cost will I have to pay?
    Generally, the employer must contribute at least 50% of the employee premium, but is not required to contribute to the cost of the dependent coverage.
  • Is there a penalty for not having health insurance?
    Effective January 1st, 2019, the Affordable Care Act rescinded the penalty for not having health insurance coverage. You will not be penalized at tax time.
  • What is the Affordable Care Act?
    Formally known as the Patient Protection and Affordable Care Act, also known as Obamacare. Enacted and passed into law on March 23, 2010
  • What is the Marketplace or Exchange?
    A service available in every state where individuals and families can shop and enroll in private medical insurance.
  • What is a short-term medical policy?
    These policies offer health insurance for a limited period and can be a solution for people between jobs, waiting for group health coverage to start or need a more affordable solution.
  • What is the difference between an HMO and a PPO plan?
    HMO Plans: Navigating the health care industry on your own can be complicated. There are lots of doctors out there. And it's hard to know which ones will be the right fit for you. At times, you might feel like you're the only one advocating for your health. HMO plans help with that. When you have an HMO plan, you choose a primary care physician who works as your partner. They coordinate all your care and can refer you to trusted doctors and specialists in your network. Another thing to know about HMO plans is that most health care isn't covered outside your network. That means if you're traveling outside your coverage area, only cover emergency or urgent care in most cases. PPO Plans: PPO plans have more flexibility than HMO plans. You don’t need a primary care physician. You can see doctors inside or outside your network. But if you stay in your network, you’ll pay less.
  • What is a Health Savings Account?
    A type of account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses. By using untaxed dollars in a Health Savings Account (HSA) to pay for deductibles, copayments, coinsurance, and some other expenses, you may be able to lower your overall health care costs.
  • Can I be denied for pre-existing illness?
    All Marketplace plans must cover treatment for pre-existing medical conditions. You cannot be charged more premium or refused coverage.
  • When is Open Enrollment?
    November 1st through December 15th.
  • When do I need to sign up for Medicare?
    5 Important Facts: Some people get Medicare automatically, and some have to sign up. You may have to sign up if you’re 65 (or almost 65) and not getting Social Security. There are certain times of the year when you can sign up or change how you get your coverage. If you sign up for Medicare Part B when you’re first eligible, you can avoid a penalty. You can choose how you get your Medicare coverage. You may be able to get help with your Medicare costs.
  • How do I sign up?
    By visiting the Medicare website at www.medicare.gov
  • What is the difference between a Medicare Supplement (MEDIGAP) plan and Medicare Advantage?
    Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like: Copayments Coinsurance Deductibles Medicare Advantage Plan: An all-in-one alternative to Original Medicare. These "bundled" plans include Part A, Part B, and usually Part D. Most plans offer extra benefits—like vision, hearing, dental, and more. Medicare Supplement Plan (Medigap): Medigap is Medicare Supplement Insurance that helps fill "gaps" in
  • What is the late enrollment penalty?
    If you didn't get Part B when you're first eligible, your monthly premium may go up 10% for each 12-month period you could've had Part B, but didn't sign up. In most cases, you'll have to pay this penalty each time you pay your premiums, for as long as you have Part B. And, the penalty increases the longer you go without Part B coverage. Usually, you don't pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period. Read more about different situations that may affect when you decide to get Part B. If you have limited income and resources, your state may help you pay for Part A, and/or Part B. You may also qualify for Extra Help to pay for your Medicare prescription drug coverage. Example: Your Initial Enrollment Period ended December 2016. You waited to sign up for Part B until March 2019 during the General Enrollment Period. Your coverage starts July 1, 2019. Your Part B premium penalty is 20% of the standard premium, and you’ll have to pay this penalty for as long as you have Part B. (Even though you weren't covered a total of 27 months, this included only 2 full 12-month periods.) Part D Later Enrollement Penalty: The late enrollment penalty is an amount that's permanently added to your Medicare drug coverage (Part D) premium. You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there's a period of 63 or more days in a row when you don't have Medicare drug coverage or other creditable prescription drug coverage. You’ll generally have to pay the penalty for as long as you have Medicare drug coverage.
  • Donut hole?
    Most Medicare drug plans have a coverage gap (also called the "donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs. Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. Once you and your plan have spent $4,130 on covered drugs in 2021, you're in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.
  • Can I enroll anytime?
    When you're first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you're eligible for Medicare when you turn 65, you can sign up during the 7-month period that: Begins 3 months before the month you turn 65 Includes the month you turn 65 Ends 3 months after the month you turn 65
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