Picking a Healthcare Plan? 10 Smart Questions to Ask 2023

Picking a Healthcare Plan? 10 Smart Questions to Ask Your Insurance Agent

Picking a Healthcare Plan? 10 Smart Questions to Ask Your Insurance Agent

It can be incredibly relieving to know that your Healthcare expenses are covered for the upcoming year. Thanks to the Affordable Care Act (ACA), millions of Americans can now access health insurance. In order to find the health insurance option that best suits your needs, you can browse the options available on the ACA’s marketplace. Call (888) 851-1506 to find out more about the plans that are offered.

How do you choose the best health plan these days when there are more options than ever?

Insurance agents who are licensed to do so can help. They are qualified professionals who assist you in finding a plan and completing the enrollment process at no additional cost to you. Agents can evaluate your unique health requirements and spending limitations and offer recommendations for your circumstances.

Tasha Riggs asserts that “agents are experts on health plans.”. She operates out of Westminster, Colorado, as a registered agent. “As a broker, I have access to each and every plan [in my region for which I am licensed].”. I ascertain your requirements and preferences for a health plan. Using my expertise, we are able to narrow the field down to two or three plans that would meet your criteria. “.

Try asking your licensed insurance agent one of these ten questions.

An authorized insurance agent can assist you in weighing your options. Call us at (888) 851-1506 or begin online right now.


Picking a Healthcare Plan? 10 Smart Questions to Ask Your Insurance Agent
Picking a Healthcare Plan? 10 Smart Questions to Ask Your Insurance Agent


1. What makes an ACA plan desirable to me?

Customers of health insurance plans are given rights and protections under the ACA. Additionally, “essential” benefits like preventive care and mental health services are provided by all ACA plans.

According to Riggs, “every single major medical health insurance policy has to abide by that law.”. Consequently, you can be confident that your chosen plan will provide complete coverage.

Additionally, ACA plans offer subsidies to help you pay for your plan if you qualify, so you could save money on your coverage. The monthly premium costs of the plan are reduced by subsidies, which are income-based credits. Many Americans who have an ACA plan are eligible for a subsidy.

2. How does looking for an ACA plan work?

The U.S. government oversees most states’ ACA marketplaces. S. a national government. However, some states might have their own.

Although these federal and state marketplaces offer these plans, you can also find them by shopping with a licensed insurance agent. To begin, for instance, click here or call (888) 851-1506 to speak with an authorized agent right away.

3. If so, how much of a subsidy will I be eligible for?

Your ability to file taxes and your income are both factors. Your monthly premiums or out-of-pocket expenses may be reduced by tax credits that you are eligible for. In fact, 4 out of 5 people who are looking for an ACA plan can find options that, after tax credits, cost less than $10 per month.

You will be questioned about your income in general whether you work with an insurance agent or submit an online application. Your most recent tax return can serve as a guide. You’ll need to estimate in good faith based on your most recent earnings if you’re self-employed. Your accountant can offer assistance in a brief conversation.

4. What expenses should I consider when looking for an ACA plan?

Your monthly health plan bill (premium) and potential medical expenses must be taken into account when selecting an ACA plan that fits your budget. Your potential medical expenses are determined by the deductible, copays, and coinsurance of the plan.

You have to pay your deductible first, and then your insurance will cover the rest. For particular medical services, such as doctor visits or prescriptions, a copay is a predetermined cost. When your insurance only covers a portion of your bill (leaving you to cover the balance), this is referred to as coinsurance.

The maximum out-of-pocket limit is another figure to pay attention to, advises Riggs. The next most crucial number to know, after the premium, is the maximum out-of-pocket, according to her. Your annual payment obligation is capped at that sum. Your plan will pay 100% of your eligible medical expenses for the remainder of the year once you’ve reached that cap.

The maximum amount “tells you the most you’re going to spend,” claims Riggs. “That is the secret number that everyone must know. Remember that only services covered by your insurance plan are included in this amount.

5. Do I need a certain amount of health insurance?

Your individual healthcare needs and financial situation will determine how much insurance you require. When comparing coverage, start by comparing coverage according to the plan level. A “metal” level system is used to group ACA plans:.





The most affordable monthly premiums are typically found in bronze plans, but you will pay more out of pocket for medical care. The highest monthly costs, but lower out-of-pocket expenses, are typically associated with platinum plans.

A bronze or silver plan might be the best option for you if you’re generally healthy and don’t require much medical attention. A gold or platinum plan may be more advantageous for you if you anticipate incurring significant healthcare costs, such as if you have a chronic condition that necessitates extensive treatment.

6. What if my medical requirements alter?

Your healthcare plan is not a permanent commitment. You will have the opportunity to compare plans and make changes each year during Open Enrollment, which starts in November. You will then have the opportunity to enroll in a new plan that will begin the following year.

You can switch to a plan that offers the coverage you require if your healthcare needs change, such as if you were recently diagnosed with diabetes. An insurance provider cannot reject you because of a preexisting condition because of the ACA.

It’s a good idea to compare plans and speak with your insurance agent each year, even if you don’t believe you need to switch.

Riggs says, “I ask everyone to call me every year so that we can go over their plan.”. “Things in this industry change so quickly. There might be a brand-new perk available that you’re passing up with another company. “.

During what is known as a Special Enrollment Period, specific life events may also permit you to change plans outside of the Open Enrollment Period. A qualifying life event, such as one of the following, will give you a window of time to enroll in or change plans.

Getting wed or getting a divorce.

Adopting or bearing a child.

Losing your medical insurance.

Examples include losing a job that offered health insurance or turning 26 and leaving your parent’s plan.

A change of state or ZIP code.

Call an authorized insurance agent at (888) 851-1506 if you believe you are eligible for a Special Enrollment Period. They can assist you in discovering a new health plan that meets your requirements.

Picking a Healthcare Plan? 10 Smart Questions to Ask Your Insurance Agent
Picking a Healthcare Plan? 10 Smart Questions to Ask Your Insurance Agent


7. Will my preferred healthcare providers be covered?

Insurance providers form networks and agree to set prices for their services. Ensure that your preferred healthcare provider is covered by the network of the insurance plan you select if you really want to stick with them.

Going outside of the network may result in much higher costs. Ask your agent or the insurance provider to verify the plan’s details. You should also follow suit if you have a preferred hospital.

8. How about my prescriptions?

Not all plans cover all prescription medications. You can examine a plan’s drug formulary in the same way that you can examine its provider network. The formulary includes a list of all the prescription drugs that the plan covers along with their costs. Verify that your prescriptions are covered and assess the costs of various plans.

9. Should I look into an HMO or PPO plan?

You may notice that some insurance plans are referred to as PPOs and others as HMOs as you browse the options. What makes a difference?

You can only visit providers who are part of the HMO (Health Maintenance Organization) plan’s network. The majority of plans also demand that you obtain a referral from your primary care physician before visiting any other types of providers. These restrictions can improve the coordination of your care while lowering costs.

You have access to a network of healthcare professionals with a PPO (Preferred Provider Organization) plan, but you are also free to seek treatment from any healthcare professional you choose. But if you leave the network, your costs will increase.

Everyone believes that if they have a PPO plan, they can visit any doctor, anywhere. Technically, that is correct, says Riggs. “However, you’ll pay significantly more if that doctor is not in the network. In other words, even though you have a PPO, you generally don’t want to leave your network. “.

You are frequently constrained to providers in a specific area because of provider networks. You might want to look for a plan that includes virtual care if you frequently travel or divide your time between two or more locations. Numerous insurance plans provide telehealth services that enable you to receive care whenever and wherever you need it. “You just pick up the phone, call a doctor, and get a prescription over the phone,” claims Riggs.

Additionally, you don’t need to be concerned about unexpected events. By law, a medical emergency while traveling must be handled as if it were an in-network emergency, according to Riggs. If you receive emergency care outside of the network, your insurance company cannot increase the cost to you.

10. How can I get more assistance if I need it?

If you have any questions or issues, call your insurance agent. And even after you purchase a plan, they continue to assist you.

In addition to helping clients choose a plan, Riggs pledges to offer “white-glove service” after the client has chosen a plan. “I’ll aid you in filing claims. Let me explain a bill to you. “.

If you’re looking for a new ACA plan and are prepared to get started, Health Markets can assist you in finding health insurance at no additional cost to you. Start looking over your choices online right away.

Also Read;

Healthcare Reform News Updates


Find more information on Healthcare from an official website of the United States government:


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