Common Health Insurance Terms


Would my health plan cover death?

While your plan might cover any medical expenses prior to death, any life insurance is not included. This would need to be purchased separately (also written by our agency).

Is health insurance required?

It is not illegal to be uninsured, but you will face tax penalties if you do not carry coverage.

What costs are included in health insurance plans?

a. Co-payments: with a co-payment, the insurance company agrees to pay for a service, but you must cover a pre-set cost, such as $20. This cost applied every time you schedule a service that has an assigned co-pay; co-pays can be higher or lower depending on the plan or according to the service provided. The affordable care act mandates that most routine preventative-care procedures be covered in full without a co-pay.
b. Deductibles: a deductible is the amount of money that you are required to pay before your insurance begins to cover services. Normally, you will either need to meet a deductible or pay a co-pay amount.
c. Coinsurance: Some policies might have co-insurance, which required you to pay a certain percentage of services rendered until you meet your out of pocket maximum. Your coinsurance may be an amount you pay in addition to your co-ay and may apply towards your deductible.
d. Monthly payments: You will pay a monthly amount each month to have the plan and keep it active.

Do the plans include dental care?

You can get dental plans through the marketplace, or a standalone plan (written also through our agency).

Can I still see my existing doctor?

In most cases, access to doctors stay the same. Health insurance plans will contract with networks of doctors, specialists, and hospitals. As long as your doctor is contracted with your plan, you are good to continue seeing them.

Can my application be declined?

Insurance companies cannot decline your application for health insurance due to pre-existing medical conditions or for any other health related reason.

What kinds of plans are available on the exchanges?

Plans are offered by private insurance companies with a range of prices and features. Our brokerage includes companies from Select Health, Molina, and University of Utah. Plans include things like, trips to the doctor, prescription drugs, specialist care, diagnostics and testing, and more, depending on the plan.

When can I sign up for health insurance?

Open enrollment exists between November 1st through December 15th. You can enroll outside of this period if you experience a life change (such as moving, marriage, divorce, loss of job, loss of coverage, or change in income).

How do I apply for the subsidy?

When submitted your application, the subsidy is already calculated and applied to the monthly payment plan.

Am I eligible for a subsidy?

Qualifications include:
i. Being a US citizen, or otherwise legally present
ii. You cannot be incarcerated
iii. Your household income (MAGI) must be between 100% and 400% of the Federal Poverty Level (FPL). Which is approximately $12,000 – $48,000 for an individual and $24,000 – $98,000 for a family of 4.

What is a subsidy?

a. The Affordable Care Act provides government subsidies (also called tax credits) to eligible consumers. The goal of these subsidies is to make health insurance more affordable. They are calculated based on annual income. The subsidy is used to help pay your monthly payments.
b. You also get subsidys that help lower your deductible and amount of co-insurance.

What is the health insurance marketplace?

a. Also known as health insurance exchanges, the online health insurance marketplace is where consumers can shop for and buy health insurance during open enrollment periods. The idea is that you will be able to compare health plan choices, determine if you are eligible for a tax credit (called a subsidy) and find out if you qualify for Medicaid.