The Affordable Care Act, also known as Obamacare, requires everyone to have health insurance coverage or potentially face a tax penalty. The good news is that this new health care environment may offer better coverage options than you’ve had in the past. If you don’t have group coverage from an employer, KeenanDirect can help you take advantage of this very important opportunity to get the health insurance you and your family need at an affordable price.
KeenanDirect is dedicated to providing you with a variety of health insurance resources. We want you to have all the information you need to choose the health insurance coverage that is right for you.
Health Insurance FAQs
Here are answers to some of the most frequently asked health insurance questions when it comes to finding the right health care plan to meet your needs.
Why do I need health insurance?
“The best person to take care of the older person you will someday be, is the younger person you are now.” Even if you are young and healthy, there are many benefits to having health insurance. The truth is that life can be unpredictable, and you never know when you might get sick or have an accident. With an affordable health insurance plan, you don’t have to worry about unexpected costs. And regular preventative care can go a long way toward making sure you stay healthy.
How does health insurance work?
Health insurance can help you pay for the medical care you and your family need. If you get sick or have an accident, health insurance can help protect you from having to pay the full cost of medical services. Depending on the plan you choose, you will pay a predetermined amount, called a “premium,” each month in order for your health coverage to be in force. Most plans have other costs you may be required to pay when you go to the doctor or hospital, but these “copayment” amounts (or “copay” for short) are usually much less than what you would have paid without insurance. Most plans also include preventative care at no additional cost. All plans have an “out-of-pocket maximum” amount that limits the total amount you spend on health care in a given year, regardless of how much health care you need.
What is covered?
Under the Affordable Care Act, also known as Obamacare, all newly purchased insurance plans are required to cover essential health benefits such as doctor visits, hospitalization, emergency care, maternity care, pediatric care for children, and prescriptions.
What is the difference between an HMO and a PPO?
A health maintenance organization (HMO) arranges for coverage of specified health services for plan members at a fixed, prepaid premium. HMOs typically require members to select a primary care physician who functions as a gatekeeper to the use of specialists and diagnostic tests. A Preferred Provider Organization (PPO) is an arrangement between providers, who offer services at a discounted rate, and an insurer, who in return offers to grant those providers preferred status. PPO members have incentives (such as lower deductibles and copayments) to use these preferred providers. PPOs are well received by members due to their increased “freedom of choice” and flexibility of care, however, premiums and out of pocket expenses for a PPO are generally higher than for an HMO.
What is Open Enrollment?
Open enrollment is the designated time period in which you can sign up for health care coverage for the upcoming calendar year. Open enrollment happens once a year, usually beginning in late Fall.
What if my life circumstances change once open enrollment has ended?
If you experience a “qualifying life event” outside of the open enrollment period, you may be eligible for special enrollment to get the coverage you need. A qualifying life event could include: getting married, having a baby, having a substantial change in income, losing your current health insurance, or moving to a new state. There are many other circumstances that may be considered a “qualifying life event” that would enable you to get health insurance at any time of the year. Contact us today to learn more.
How much does health insurance cost?
This will depend on the kind of health care plan you choose (Bronze, Silver, Gold or Platinum), and how much health care you use each year. You can expect to pay a monthly premium, or fee that an insurance company charges in exchange for insurance coverage. Some plans also require copayments, or specified charges for a specified service, such as a $30 fee for an office visit that you pay when you see a doctor. All insurance plans have an “out-of-pocket maximum” amount that limits the total amount you spend on health care in a given year, regardless of how much health care you need. We can help you find a health care plan to fit your needs and budget.
Can I still go to my doctor?
If you want to stay with your doctor, make sure he/she is part of the network of your new insurance plan. You can ask your doctor which insurance plans they accept, or simply search the plan’s network to find their name before you choose a plan.
What kind of prescription drug coverage will my plan include?
Prescription drug coverage is included with all new health care plans under the Affordable Care Act. Different plans provide different levels of coverage. Plans may also have various deductibles for prescription drug coverage.
Am I eligible for a subsidy?
Under the Affordable Care Act, also known as Obamacare, many individuals and families are eligible to receive subsidized health insurance coverage if they are not eligible for Medicare or Medicaid and are not offered affordable coverage through their employer. Your eligibility depends on factors such as your annual household income and how many people are in your household. Try our calculator to find out if you are eligible for a subsidy.
What is the tax penalty for no health insurance?
Under Obamacare, if you can afford to buy health insurance but choose not to get coverage, you must pay a penalty or fee when you file your federal tax return. This penalty is calculated as a percentage of your household income, or as a per person fee, whichever is higher.
How do I shop?
You have come to the right place! We can help you compare health care plans and find the best one to fit your needs and budget.