Health Insurance Made Easy!

Important Note!
Don't forget to mention.

• Deductibles

  A deductible is the amount you pay annually before your insurance covers expenses. For example, a $3,000 deductible means you pay that amount before full coverage begins. If you have dependents, there will be separate individual and family deductibles, with the latter typically higher.

• Coinsurance

  Coinsurance is the percentage you pay for covered medical expenses after meeting your deductible. For instance, an "80/20" plan means your insurance covers 80% and you pay 20% until reaching the maximum out-of-pocket limit. Note that coinsurance only applies to covered services, so any expenses for services not covered are your responsibility.

• Copay

  Copays are set amounts you pay for medical services. They can vary based on the type of care you receive. Copays typically apply to office visits, specialist visits, urgent care, emergency room visits, and prescriptions. Your copay applies regardless of whether you've met your deductible. For instance, if you have a $50 specialist copay, you'll pay that amount for a specialist visit, regardless of your deductible status.

• Out-of-Pocket Maximums

  Out-of-pocket expenses are healthcare costs not covered by insurance until you reach your deductible. Once you hit the out-of-pocket maximum, your plan covers 100% of covered services. Deductibles, copays, and coinsurance count towards the maximum, but premiums and uncovered services don't. Limits may vary for individuals and families. The maximum allowed under the Affordable Care Act is $8,550 for individuals and $17,100 for families.

• In-Network vs. Out-of-Network

  Some plans have separate costs and limits for in-network and out-of-network providers. In-network providers have negotiated rates, while out-of-network providers are more expensive. In-network doesn't always mean nearby, so check if your preferred doctors are in-network. Consider switching plans if necessary during open enrollment.

• Affordable Care Act (ACA / Obamacare)

  The ACA guarantees health insurance for all, covering preexisting conditions and essential benefits. It has an annual Open Enrollment Period where anyone can sign up for health insurance or switch plans, typically from October to January but may vary by state. Outside of this period, only qualifying events may allow enrollment such as a change in job. The ACA aims to lower your healthcare costs and make insurance affordable.