Frequently Asked Questions
Why do I need health insurance?
Health insurance helps protect you from the high cost of medical care. Even a simple visit to the doctor or urgent care can add up quickly, and a major illness or hospital stay can cost thousands of dollars without coverage.
Having health insurance means you pay less out of pocket for medical services, preventive care, prescriptions, and emergencies. It also gives you access to a network of doctors and hospitals so you can get the care you need when you need it.
What’s the difference between a deductible, copay, and coinsurance?
These are three key terms that describe how you share costs with your insurance company:
Deductible: The amount you pay each year before your insurance starts to share costs.
Copay: A flat fee (like $25 or $40) you pay for certain services such as office visits or prescriptions.
Coinsurance: A percentage of costs you pay after meeting your deductible. For example, your plan might pay 80% and you pay 20%.
Understanding these terms helps you estimate what you’ll actually pay when you use your insurance.
What is the “out-of-pocket maximum”?
This is the most you’ll have to pay for covered medical services in a plan year. Once you reach this amount, your insurance company pays 100% of covered costs for the rest of the year.
It includes your deductible, copays, and coinsurance, but not your monthly premium.
What are the different types of health insurance plans?
The main types you’ll see are:
HMO (Health Maintenance Organization): You choose a primary care doctor and need referrals for specialists. Usually lower premiums, but less flexibility.
PPO (Preferred Provider Organization): More flexibility - you can see specialists without referrals, and you’re covered (to a degree) even if you go out of network.
EPO (Exclusive Provider Organization): A mix between an HMO and PPO - lower costs, but no out-of-network coverage except emergencies.
POS (Point of Service): Requires a primary care doctor but allows limited out-of-network options.
I can help you compare these types to decide which fits your needs best.
What does “in-network” mean, and why does it matter?
“In-network” refers to doctors, hospitals, and other providers that have agreed to work with your insurance company at discounted rates.
When you stay in-network, you pay less. Going “out-of-network” often means higher bills, or sometimes no coverage at all.
Before making appointments, it’s always best to double-check that your provider is in your plan’s network.
What does health insurance cover?
Most plans cover a wide range of medical services, including:
Preventive care (checkups, screenings, and vaccines)
Doctor visits and hospital stays
Prescription drugs
Maternity and newborn care
Mental health services
Emergency care
Pediatric services for children
Preventive care is often covered at no cost, even before you meet your deductible.
What is the Health Insurance Marketplace (ACA or “Obamacare”)?
The Health Insurance Marketplace is a federally regulated platform where you can shop for and enroll in qualified health plans under the Affordable Care Act (ACA).
Depending on your income, you may be eligible for subsidies or tax credits that reduce your monthly premiums. I can help you determine if you qualify and compare Marketplace and private plan options.
Can I get health insurance if I’m self-employed?
Yes! If you’re self-employed or run your own business, you can buy an individual or family plan directly through the Marketplace or from private insurers.
You may also qualify for special tax deductions for your premiums. I specialize in helping self-employed professionals find affordable plans that provide strong coverage and flexibility.
When can I enroll in health insurance?
Most people can enroll during the Open Enrollment Period, which typically runs from November through mid-January each year.
However, you may qualify for a Special Enrollment Period if you’ve had a major life event such as losing coverage, getting married, having a baby, or moving to a new area.
If you’re not sure whether you qualify, I can help you find out and guide you through the enrollment process.
What if I can’t afford health insurance?
There are more affordable options than many people realize. Depending on your income, you may qualify for subsidies through the Marketplace or even for low-cost state or federal programs.
I’ll help you explore every option (including private plans) to make sure you find coverage that fits your needs and your budget.
What’s the difference between Marketplace and private insurance?
Marketplace plans are standardized and often include income-based subsidies. Private insurance plans (off-exchange) may offer more flexibility, additional coverage options, or access to broader provider networks, but they aren’t subsidy-eligible.
I can help you compare both types side by side to determine which gives you the best balance of benefits and cost.
Can I keep my doctor when I change plans?
In many cases, yes, but it depends on whether your doctor is in-network for your new plan.
Before you switch, I can check your providers for you and help you choose a plan that keeps the doctors and specialists you trust.
What happens if I miss a premium payment?
Most plans include a grace period (typically 30 days) to make a late payment. If you miss that window, your coverage could lapse, which might require you to reapply, possibly at a higher rate.
Setting up automatic payments can help you avoid any interruptions in coverage.
How can you help me with health insurance?
I’m an independent health insurance advisor based in Orlando, Florida, and my goal is simple: to make health insurance easier to understand and easier to manage.
I’ll explain your options clearly, help you compare plans, walk you through enrollment, and be here for you year after year as your needs change. You’ll always have someone you can call, not a call center.
How do I get started?
It’s easy! Schedule a free consultation, and we’ll talk through your needs, budget, and goals. I’ll provide clear recommendations and handle the details so you can make confident, informed decisions about your health coverage.
Contact me today to get started and take the first step toward simpler, smarter health insurance.
Health insurance can be confusing, but it doesn’t have to be. Below are answers to some of the most common questions people ask about choosing, using, and understanding their coverage. Whether you’re an individual, a family, or a small business owner, this page is here to help you find clear, simple explanations you can trust.
If you don’t see your question listed, or if you’d like help reviewing your plan options, please feel free to contact me. I’m always happy to help explain your choices and guide you toward the right coverage.
Frequently Asked Questions
Why do I need health insurance?
Health insurance helps protect you from the high cost of medical care. Even a simple visit to the doctor or urgent care can add up quickly, and a major illness or hospital stay can cost thousands of dollars without coverage.
Having health insurance means you pay less out of pocket for medical services, preventive care, prescriptions, and emergencies. It also gives you access to a network of doctors and hospitals so you can get the care you need when you need it.
What’s the difference between a deductible, copay, and coinsurance?
These are three key terms that describe how you share costs with your insurance company:
Deductible: The amount you pay each year before your insurance starts to share costs.
Copay: A flat fee (like $25 or $40) you pay for certain services such as office visits or prescriptions.
Coinsurance: A percentage of costs you pay after meeting your deductible. For example, your plan might pay 80% and you pay 20%.
Understanding these terms helps you estimate what you’ll actually pay when you use your insurance.
What is the “out-of-pocket maximum”?
This is the most you’ll have to pay for covered medical services in a plan year. Once you reach this amount, your insurance company pays 100% of covered costs for the rest of the year.
It includes your deductible, copays, and coinsurance, but not your monthly premium.
What are the different types of health insurance plans?
The main types you’ll see are:
HMO (Health Maintenance Organization): You choose a primary care doctor and need referrals for specialists. Usually lower premiums, but less flexibility.
PPO (Preferred Provider Organization): More flexibility - you can see specialists without referrals, and you’re covered (to a degree) even if you go out of network.
EPO (Exclusive Provider Organization): A mix between an HMO and PPO - lower costs, but no out-of-network coverage except emergencies.
POS (Point of Service): Requires a primary care doctor but allows limited out-of-network options.
I can help you compare these types to decide which fits your needs best.
What does “in-network” mean, and why does it matter?
“In-network” refers to doctors, hospitals, and other providers that have agreed to work with your insurance company at discounted rates.
When you stay in-network, you pay less. Going “out-of-network” often means higher bills, or sometimes no coverage at all.
Before making appointments, it’s always best to double-check that your provider is in your plan’s network.
What does health insurance cover?
Most plans cover a wide range of medical services, including:
Preventive care (checkups, screenings, and vaccines)
Doctor visits and hospital stays
Prescription drugs
Maternity and newborn care
Mental health services
Emergency care
Pediatric services for children
Preventive care is often covered at no cost, even before you meet your deductible.
What is the Health Insurance Marketplace (ACA or “Obamacare”)?
The Health Insurance Marketplace is a federally regulated platform where you can shop for and enroll in qualified health plans under the Affordable Care Act (ACA).
Depending on your income, you may be eligible for subsidies or tax credits that reduce your monthly premiums. I can help you determine if you qualify and compare Marketplace and private plan options.
Can I get health insurance if I’m self-employed?
Yes! If you’re self-employed or run your own business, you can buy an individual or family plan directly through the Marketplace or from private insurers.
You may also qualify for special tax deductions for your premiums. I specialize in helping self-employed professionals find affordable plans that provide strong coverage and flexibility.
When can I enroll in health insurance?
Most people can enroll during the Open Enrollment Period, which typically runs from November through mid-January each year.
However, you may qualify for a Special Enrollment Period if you’ve had a major life event such as losing coverage, getting married, having a baby, or moving to a new area.
If you’re not sure whether you qualify, I can help you find out and guide you through the enrollment process.
What if I can’t afford health insurance?
There are more affordable options than many people realize. Depending on your income, you may qualify for subsidies through the Marketplace or even for low-cost state or federal programs.
I’ll help you explore every option (including private plans) to make sure you find coverage that fits your needs and your budget.
What’s the difference between Marketplace and private insurance?
Marketplace plans are standardized and often include income-based subsidies. Private insurance plans (off-exchange) may offer more flexibility, additional coverage options, or access to broader provider networks, but they aren’t subsidy-eligible.
I can help you compare both types side by side to determine which gives you the best balance of benefits and cost.
Can I keep my doctor when I change plans?
In many cases, yes, but it depends on whether your doctor is in-network for your new plan.
Before you switch, I can check your providers for you and help you choose a plan that keeps the doctors and specialists you trust.
What happens if I miss a premium payment?
Most plans include a grace period (typically 30 days) to make a late payment. If you miss that window, your coverage could lapse, which might require you to reapply, possibly at a higher rate.
Setting up automatic payments can help you avoid any interruptions in coverage.
How can you help me with health insurance?
I’m an independent health insurance advisor based in Orlando, Florida, and my goal is simple: to make health insurance easier to understand and easier to manage.
I’ll explain your options clearly, help you compare plans, walk you through enrollment, and be here for you year after year as your needs change. You’ll always have someone you can call, not a call center.
How do I get started?
It’s easy! Schedule a free consultation, and we’ll talk through your needs, budget, and goals. I’ll provide clear recommendations and handle the details so you can make confident, informed decisions about your health coverage.
Contact me today to get started and take the first step toward simpler, smarter health insurance.
Health insurance can be confusing, but it doesn’t have to be. Below are answers to some of the most common questions people ask about choosing, using, and understanding their coverage. Whether you’re an individual, a family, or a small business owner, this page is here to help you find clear, simple explanations you can trust.
If you don’t see your question listed, or if you’d like help reviewing your plan options, please feel free to contact me. I’m always happy to help explain your choices and guide you toward the right coverage.
