General Health Insurance Questions
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Why do I need health insurance if I’m healthy?
The amount of money you must pay out-of-pocket for covered services before your insurance plan starts to pay.
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What does health insurance typically cover?
Most plans cover:
- Doctor visits
- Emergency care
- Hospitalization
- Prescription drugs
- Mental health services
- Maternity and newborn care
- Preventive services
- Pediatric care (including dental and vision)
- Lab tests
- Rehabilitation and therapy
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What’s the difference between in-network and out-of-network providers?
In-network providers have agreements with insurance carriers to offer care at discounted rates. Out-of-network providers may cost significantly more, and some plans don’t cover them at all, except in emergencies.
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What are premiums, deductibles, copays, and coinsurance?
- Premium: What you pay monthly to keep your plan active
- Deductible: What you pay out-of-pocket before your insurance kicks in (excludes copays)
- Copay: A fixed fee you pay for specific services (like a $25 doctor visit)
- Coinsurance: The percentage you split with your insurance carrier after the deductible (e.g., 80/20 split)
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What is an out-of-pocket maximum?
This is the most you’ll ever pay in a year for covered services. After reaching this cap, your insurance pays 100% for in-network covered expenses.
Questions for Self-Employed & 1099 Contractors
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Can I get health insurance if I’m self-employed or a 1099 worker?
The amount of money you must pay out-of-pocket for covered services before your insurance plan starts to pay.
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Are there affordable options for people without employer-sponsored insurance?
Most plans cover:
- Doctor visits
- Emergency care
- Hospitalization
- Prescription drugs
- Mental health services
- Maternity and newborn care
- Preventive services
- Pediatric care (including dental and vision)
- Lab tests
- Rehabilitation and therapy
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What kind of plan should I look for as a 1099 worker?
That depends on your income, medical needs, and lifestyle. You may want:
- PPO plans if you want provider flexibility (recommended)
- HDHPs if you’re looking to save monthly and pair with an HSA
- Short-term medical plans if you need temporary, budget-friendly coverage
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Can I write off my health insurance premiums as a business expense?
If you're self-employed, yes, health insurance premiums may be tax-deductible. Be sure to consult a tax professional for guidance based on your specific situation.
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What if I only work part-time or seasonally as a contractor?
You can still get covered. We’ll help you find plans that fit your work schedule and provide protection year-round, even if your income or hours fluctuate.
Understanding Your Coverage
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How do I know what’s covered under my plan?
Each plan has a Summary of Benefits and Coverage (SBC) that explains exactly what’s included, like copayments, covered services, exclusions, and limitations. We'll walk you through it.
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Are preventive services covered?
Yes. Most plans include free preventive care, like annual check-ups, cancer screenings, vaccinations, and more even if you haven’t met your deductible.
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What if I have a pre-existing condition?
That depends on your income, medical needs, and lifestyle. You may want:
- PPO plans if you want provider flexibility (recommended)
- HDHPs if you’re looking to save monthly and pair with an HSA
- Short-term medical plans if you need temporary, budget-friendly coverage
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Is maternity care included?
If you're self-employed, yes, health insurance premiums may be tax-deductible. Be sure to consult a tax professional for guidance based on your specific situation.
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Can I get coverage for dental and vision?
Some plans include dental and vision, especially for children. For adults, we can help you bundle separate dental and vision coverage with your health insurance.
Choosing the Right Plan
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What are the different types of plans?
- HMO: Lower cost, but you need referrals and must stay in-network
- PPO: More provider flexibility, no referrals needed
- EPO: In-network only but no referrals
- HDHP: Lower monthly cost, higher deductible, compatible with HSA
- Catastrophic: Low-cost plans with high deductibles, best for young, healthy individuals or temporary coverage
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How do I know which plan is right for me?
Yes. Most plans include free preventive care, like annual check-ups, cancer screenings, vaccinations, and more even if you haven’t met your deductible.
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Can I change my plan later?
Yes. You can change your plan during the Open Enrollment Period (usually in the fall) or if you qualify for a Special Enrollment Period due to life changes like losing coverage, getting married, or having a baby.
Enrollment & Support
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Is it hard to sign up for a plan?
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Can someone help me compare plans?
Yes. Most plans include free preventive care, like annual check-ups, cancer screenings, vaccinations, and more even if you haven’t met your deductible.
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What if I don’t understand the policy terms?
That’s what we’re here for. We break down complex insurance language into simple, understandable terms. No jargon, no confusion.
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What if I need help using my insurance after I enroll?
We don’t disappear after signup. If you need help with finding a doctor, billing issues, or filing claims, our support team is always ready to help.
Life Situations & Special Needs
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Can I get insurance if I’m between jobs or just started freelancing?
The amount of money you must pay out-of-pocket for covered services before your insurance plan starts to pay.
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What if I only need temporary coverage?
The most you'll have to pay for covered healthcare services in a plan year. After you reach this amount, your insurance pays 100% of the costs for covered benefits.
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Is there coverage for my family, too?
Definitely. Whether you're covering a spouse, children, or a full household, we’ll help you find family plans that provide strong coverage at a price you can afford.