COMMON QUESTIONS

What is a deductible?

This is an initial out of pocket expense. This is the amount you have to pay each year for covered health services before the insurer will start to chip in. Some plans may have separate individual & family deductibles and/or deductibles for separate services such as hospitalization. 

What is a copayment?

This is another amount paid by the insured. A copayment is a fixed amount you pay toward each medical service. For an example, $25 for a checkup. 

What is coinsurance?

Is a fixed percentage that the insured must pay toward each service. This is NOT a flat rate amount. 

What is considered in-network?

When a doctor, hospital or other health provider accepts your health insurance plan. They are also known as participating providers. 

What is considered out-of-network?

When a doctor, hospital or other health provider does NOT accepts your health insurance plan. 

HMO?

These plans do NOT include out-of-network benefits. Simply put, if the insured goes to a provider for non-emergency care who doesn't accept your plan, the insured pays ALL the costs. 

PPO?

The plans include out-of-network benefits. The PPO will assist in paying for the care you have received from providers that don't accept your plan. 

For an example, your plan may pay 80% & you must pay 20% if you obtain health services from an in network health care provider. If you receive health care services from an out-of-network provider, your plan may cover 60% & you would be responsible for the remaining 40%. 

Are emergency services covered by an HMO or PPO?

When you need emergency services, go directly to the closest hospital. HMO and PPO plans will help paying for medically necessary services. 

When can I change my health coverage plan?

Employer sponsored health plans:

Typically these plans can only be modified or changed during the employers open enrollment period. 

Individual ACA plans:

Can only be changed during open enrollment (November 1 - December 15) unless the individual is able to qualify for Special Enrollment. Typically  the individual needs to have a Qualifying Life Event (QLE) within 60 days to qualify for Special Enrollment. Non-ACA plans have year-round enrollment

Is health coverage tax deductible?

Health insurance is tax deductible if the individual is self-employed OR have a health savings account. If the person is self-employed, the premiums that you pay for health insurance for yourself & your dependent(s) can be deducted from your taxes. That being said, if your dependents are covered under another insurance plan, you cannot deduct those premiums. 

A health savings plan (HSA) is used in conjunction with a high deductible health plan. The individual typically must purchase these plans from an employer, although they're also offered through private insurance companies. The amount of funds that are contributed to your HSA account, up to a specific amount, is tax deductible. 

What does health coverage cost an employer?

The Affordable Care act requires all employers who have at least 50 full-time employees to provide them with subsidized health care coverage. If the individual is receiving health coverage benefits through their employer, the employer is likely paying about 3X as much as you are toward your premiums. Some individuals feel that the policies offered are lacking in coverage & may want to research other coverage options on the private market to compare costs & coverage. In some circumstances, this may be beneficial, but without an employer subsidy. Be aware that it may be harder to find a more comprehensive plan that has a comparable or better cost. 

What's first dollar coverage? 

This means there's NO deductible to pay. The insurance kicks in immediately with the first covered expense. 

What happens if I switch jobs or become self-employed? 

Obtaining your own health plan with Decision 1 Health's assistance frees you from corporate handcuffs. When you have your own health coverage, it's no longer necessary to stay in a dead-end job simply to keep your health insurance. You keep your health coverage even if you switch jobs or become self-employed. 

If you're currently between jobs, self-employed, on an ACA plan or paying massive COBRA premiums, you owe it to yourself to check out other options. In most cases across the U.S., we can assist you in finding a better plan with better coverage that could possibly also save you money. 

Are your agents licensed?

Yes. We are licensed to sell life & health products in the U.S.