WOLF HOUSE

What is health insurance? 

Health insurance is a type of insurance the helps cover the cost of medical care. It can help pay for expenses like doctor visits, hospital stays, and prescription medications. 

 

What is ObamaCare? 

The Patient Protection and Affordable Care Act, also known as Obamacare, is a health care reform law signed by President Obama in 2010. The law helps make insurance affordable, requires insurance carriers to provide coverage for pre-existing conditions, policies providing essential health benefits, and protects individuals with health problems from being charged excessive premiums. 

​Where can I go get health insurance?
Individuals in Texas who do not have health insurance through their job can obtain private short term health insurance or obtain coverage through the Affordable Care Act insurance marketplace exchange. 

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If consumers can buy insurance directly through the marketplace, why would they work with an agent? 

Agency services are free to the public. Many consumers like being able to work with an agent who can explain terms and help them compare plans. Agents also provide advice on deductibles and maximum out of pocket costs. These cost can be supplemented by other insurance products not found on the marketplace. Working with a good health insurance agent can provide clients access to these advance products that help fill in the financial gaps of their health care policy. 

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What is an HMO? 

A Health Maintenance Organization is a type of health plan that provides preventative and healthcare coverage within its network of doctors. Unlike other insurance plans, HMOs require participants to choose a primary care physician form the network and get a referral from that physician before seeing any specialists. HMOs are generally preferred by people who do not mind having their health decision managed. 

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What is an EPO? 

An Exclusive Provider Organization is a type of health plan that requires members to receive their healthcare services exclusively from the network of healthcare providers associated with the plan. Unlike an HMO, there is no need for a primary care physican before seeing a specialist. 

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What is a Deductible?

The deductible is the amount of money a person has to pay out of pocket before their insurance starts covering their medical expenses. 

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What is the difference between Copy and Coinsurance? 

A copayment, or copay, is a fixed amount that an individual must pay for a medical service or prescription drug. Copays are usually made at the time you receive the service or pick up the prescription. 

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Coinsurance is a percentage of the cost of a covered medical service that you are responsible for paying after you have met your deductible. 

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Does ACA healthcare insurance cover dental?

ACA health insurance does provide pediatric dental care but does not provide dental coverage for adults. For Adults, there are dental products you can purchase on and off exchange. Consumers should read the coverage terms carefully as the dental products differ between the carriers. 

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How do you know if you qualify for a special enrollment period? 

A special enrollment period refers to a specific time outside of the annual open enrollment period when individuals can enroll in or make changes to their health insurance plans. These periods are typically triggered by certain life events, such as getting married, having a baby, losing other health coverage, or moving to a new area. During a special enrollment period, individuals have a limited window of time to sign up for or switch health insurance plans, outside of the usual open enrollment period. 

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Why did my Medicaid coverage expire? 

The Federal Government expansion of Medicaid during the Covid pandemic as expired. This means that the temporary expansion of Medicaid eligibility criteria and coverage options have ended, resulting in some individuals who were previously covered by Medicaid no longer qualifying for the program. This can lead to a reduction in healthcare coverage for those individuals. If you have lost medicaid coverage, please reach out to a licensed agent to explore your ACA healthcare options. 

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