Frequently Asked Questions

What counts as a “pre-existing condition”?

The term “pre-existing condition” refers to any condition, symptom, etc. that existed prior to the effective date. Each type of plan has their own determined policy outline as to how it will (or will not) provide coverage for pre-existing conditions.

Do I qualify for “ObamaCare”?

“ObamaCare” is a colloquial term that refers to plans that meet the requirements of the Affordable Care Act legislation. Everyone is eligible for these plans. However, taxable income is utilized to determine how much assistance one is eligible for, if any.

Can I change plans if I don’t like mine?

You can cancel a plan any time you like. And most of the off-exchange plans can be written any time during the year. However, they do come with restrictions on coverage. Enrollment eligibility for ACA/Marketplace plans is limited to the Open Enrollment Period, unless you have a qualified life event.

What is the difference between an
HMO and a PPO?

Many don’t know the difference, but it’s dangerous when someone thinks they know, and are incorrect. The difference between an HMO and a PPO lies in how the plan performs should you end up at a medical facility that is out-of-network. With a PPO, a secondary set of benefits provides coverage in this event. However, with an HMO, there is typically no coverage at all outside of the network.

What is a deductible?

This term is often misunderstood as the point at which the insurance plan “takes over” payment for medical expenses. That is actually what is referred to as the “maximum out-of-pocket”. More specifically, the deductible is the financial threshold one must meet before the plan starts contributing at a predetermined percentage for any expenses subject to the deductible. Unfortunately, there are many off-exchange plans that offer “no annual deductible” as a benefit, which is misleading and dangerous as these plans usually have no maximum out-of-pocket, and therefore, no catastrophic coverage at all.