Insurance FAQ

Working with a broker

Does it cost anything to work with an insurance broker?

No. The insurance carriers pay me, not you. Your premium is the same whether you come through me or go direct. The difference is that someone reads the plan documents for you, and picks up the phone when a claim goes wrong.

What's the difference between using a broker and going to HealthCare.gov directly?

HealthCare.gov shows you plans. It can't tell you which one fits. I compare plans across carriers and estimate what you'd really pay out of pocket, and then I handle the enrollment. Marketplace prices are the same either way.

How is an independent broker different from a captive agent?

A captive agent sells one company's plans. That's the whole job. I'm independent, so I can compare carriers and look at your doctors and your budget before I suggest anything. Sometimes my answer is to stay where you are.

What carriers do you work with?

I'm appointed with national and regional carriers, including Blue Cross Blue Shield, Cigna, Humana, UnitedHealthOne, Ambetter and Oscar. Which of them sell where you live depends on your state and county, so we sort that out on the call.

Health insurance (under 65)

What type of health insurance do I need if I'm under 65?

It depends on where you are right now: working for someone, working for yourself, between jobs, or coming off a parent's plan. The under-65 market is my specialty, and most people's options take about 15 minutes to walk through on a call. If you'd rather start on your own, Find My Coverage shows which options are open to you.

When can I enroll in health insurance?

Open Enrollment for ACA Marketplace plans typically runs from November through mid-January. Outside that window, you may qualify for a Special Enrollment Period after a qualifying life event, such as losing coverage, getting married, having a baby or moving to a new state. Find My Coverage tells you in about 90 seconds whether a window is open for you.

I just lost my job. What are my health insurance options?

You usually have 60 days to enroll in a Marketplace plan under a Special Enrollment Period. You may also be able to keep your old plan through COBRA, though COBRA often costs a lot more. Don't wait on this one: the 60-day window is firm. If it's urgent, call me at (702) 379-9084 and we'll compare the two.

I'm turning 26 and aging off my parents' plan. What do I do?

Aging off a parent's plan qualifies you for a Special Enrollment Period, and you have 60 days to get your own coverage. It's usually quicker than people expect. Start with the check, or call me and we'll find a plan that fits your budget.

I'm self-employed. What are my options?

You can buy a Marketplace plan and may qualify for a premium tax credit based on your income. You may also be able to deduct your premiums. If you're healthy, a private plan can sometimes cost less than the Marketplace. Self-employed people are a big part of my work, and I wrote up how I decide between the two.

Can I get coverage if I have a pre-existing condition?

Yes. ACA plans have to cover pre-existing conditions, and they can't charge you more because of your health history. Plans outside the ACA work differently: short-term plans and medically underwritten private plans may exclude conditions or price by health. Before you sign anything, check which kind of plan it is.

What's the difference between an HMO and a PPO?

• HMO (health maintenance organization): you usually need a referral to see a specialist, and you stay in the network. Premiums tend to be lower.
• PPO (preferred provider organization): no referrals, and you can go out of network at a higher cost. Premiums tend to be higher.

Which is better comes down to how you use care. If there's a doctor you want to keep, I check which plans have them in network before you choose.

What is the difference between a premium, deductible, and copay?

• Premium: what you pay every month to keep the plan, whether you use it or not.
• Deductible: what you spend on covered care before the plan starts paying. With a $2,000 deductible, the first $2,000 is yours.
• Copay: a flat fee at the visit or the pharmacy counter, like $25 for a doctor visit. Many plans charge copays even before you meet the deductible.

What is an out-of-pocket maximum?

The most you'll pay for covered, in-network care in a plan year. Once you reach it, the plan pays 100% of covered costs for the rest of the year. It's the number I look at first when I compare plans, because it's your worst case.

Group and employer insurance

I own a small business. Can I offer health insurance to my employees?

Yes. If you have 1 to 50 employees, I can help you set up a group health plan. Some small businesses also qualify for a tax credit through the SHOP Marketplace. Group plans often cost less per person than individual plans. The business check lists what your company has to offer and what is up to you.

How does small group insurance work?

You pick a plan, or a few, from one carrier and decide how much the business pays toward premiums. Your employees then enroll during a set window. I do the carrier comparison and the enrollment paperwork, so you can keep running the business.

Is group insurance cheaper than individual plans?

Often. Group plans spread risk across more people, which can lower the cost per person. What the business pays toward premiums is generally tax-deductible for the business and tax-free for employees.

Life insurance

Do I need life insurance?

If someone depends on your income, like a spouse or kids, life insurance pays them if you die. Even if you're single, a small policy can cover final expenses and debts so your family isn't left with them.

What's the difference between term and permanent life insurance?

• Term life covers you for a set number of years, often 10 to 30. It's the simplest kind and costs the least. If you die during the term, your beneficiaries get the death benefit.
• Permanent life, such as whole or universal life, covers you for life and builds cash value. It costs more.

Most people start with term. My post on how much life insurance you actually need walks through the math.

How much life insurance do I need?

A common starting point is 10 to 12 times your yearly income. The real answer depends on your debts and what your family spends, and on how many years of income you'd want to replace. Savings and other assets count too. Running the numbers with me takes about 10 minutes.

Dental and vision insurance

Do I need separate dental and vision insurance?

Usually, yes. Most health plans don't cover adult dental or vision. If you want cleanings and eye exams covered, or help paying for glasses, you'll need separate plans. I can set those up alongside your health coverage.

What does dental insurance typically cover?

A common setup pays 100% for preventive care like cleanings and X-rays, 70 to 80% for basic work like fillings, and 50% for major work like crowns. Most plans also cap what they pay in a year, often between $1,000 and $2,000.

Is vision insurance worth it?

If you wear glasses or contacts, it often pays off. Most vision plans cover a yearly exam and give you an allowance for frames or contacts. If you only need an exam every couple of years, compare the premium with paying for the exam yourself.

Supplemental insurance

What is supplemental insurance?

It pays cash to you when something covered happens, such as an accident or a hospital stay. People use the money on the gaps their health plan leaves, like the deductible or lost pay while they recover.

Do I need supplemental insurance if I already have health insurance?

Health insurance pays medical bills. It won't pay the mortgage or the grocery bill while you're out sick, and that's what the supplemental cash is for. It matters most if you have a high deductible. If you have savings that would cover a rough month, you may not need it.

General

What areas do you serve?

I'm based in Henderson, Nevada, and licensed in 34 states. The licensed states page lists them, with the free lookups where you can check my license.

Can I keep my doctor if I switch plans?

Only if your doctor is in the new plan's network. Before you switch, I check your doctors against the network and your prescriptions against the drug list.

What happens if I miss Open Enrollment?

You may still qualify for a Special Enrollment Period if you've had a qualifying life event in the last 60 days, such as losing coverage, a move, a marriage or a new baby. Some private plans that aren't ACA plans enroll year-round, though they're medically underwritten. Find My Coverage checks for an open window in about 90 seconds.

How do I file a claim?

Most carriers let you file a claim in their app or on their website. If a claim gets stuck, call me and my team will help you sort it out. The claim phone numbers page lists the claim lines for the big carriers.

How do I get started?

Call me at (702) 379-9084. Most first calls take about 15 minutes. I'll ask about your situation and compare what's out there. If you'd rather pick a time, book one on my calendar.