Frequently Asked Questions

How do the Deductible, Coinsurance and Out of Pocket Maximum Work?
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Deductible:
This is the amount you must pay out of pocket for covered healthcare services before your insurance starts to pay. For example, if your deductible is $2,500, you pay the first $2,500 of your medical bills yourself each year before your plan begins to share costs.

Coinsurance:
After you meet your deductible, you pay a percentage of the costs for covered services—this is your coinsurance. For instance, if your coinsurance is 20%, you pay 20% of the bill and your insurer pays 80% until you reach your out-of-pocket maximum.

Out-of-Pocket Maximum:
This is the most you’ll pay for covered healthcare in a plan year, including your deductible, coinsurance, and copays. Once you reach this limit, your insurance pays 100% of covered in-network costs for the rest of the year. For example, if your out-of-pocket maximum is $6,000, after you’ve paid that amount (including deductible, coinsurance, and copays), you pay nothing more for covered services for the rest of the year.

What preventive care benefits must be covered for free in network on ACA and employer plans?

Here is a link to the benefits for kids, adults and women: https://www.healthcare.gov/coverage/preventive-care-benefits/

Will my Pre-Existing Condition be Covered on an ACA Individual or Employer Health Plan?

ACA - Yes! Employer plans - Yes, if it is a fully insured health plan. 

Full details are on Healthcare.gov: https://www.healthcare.gov/coverage/preventive-care-benefits/

What are the Essential Health Benefits covered by ACA Health Insurance?

Ambulatory patient services (outpatient care), Emergency services, Hospitalization, Maternity and newborn care, Mental health and substance use disorder services (including behavioral health treatment), Prescription drugs, Rehabilitative and habilitative services and devices, Laboratory services, Preventive and wellness services and chronic disease management, and Pediatric services (including oral and vision care for children).

Full details are on Healthcare.gov: https://www.healthcare.gov/coverage/what-marketplace-plans-cover/

What are my Options for Health Insurance?

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