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Health Insurance FAQs


What is Coinsurance?

This is the amount you are obligated to pay for covered medical services after you have satisfied any co-payment or deductible requirements on your plan.  It is usually expressed as a percentage that varies from plan to plan.



What is a deductible?

The deductible is the amount that must be met before the insurance company starts to cover expenses.  For many routine visits like seeing a doctor, the deductible is waived.  Meaning, make sure you check and see when your deductible will apply.




What are out-of-pocket maximums?

The out-of-pocket maximum is the most you will have to pay per year.  Once you meet this maximum, the plan covers 100% of all bills for the rest of the year.  This number resets every January so be careful.



What is a HMO?

(Health Maintenance Organization).  These types of plans are one of the most affordable in the marketplace.  This is primarily because of the managed network structure that is in place.  Individuals who have this type of coverage have to designate a primary care physician , which will be the starting point for all medical services that might be needed through out the year. 



What is a PPO?

(Preferred Provider Organization).  This is also another affordable individual health insurance plan that gives people access to all health care providers within the network.  Additionally, you can also go out of network and most plans will cover you for care as well.  This type of health insurance is flexible and affordable. 



Is their a big difference between the health insurance carriers?

Yes and no.  Insurance carriers all have competitive plans that compete against each other on a benefit basis.  The major difference between the different health insurance carriers is their network.  Not all doctors accept the same insurance.  Additionally, health insurance carriers have a larger presence in some states than others.  For instance, in California, Anthem Blue Cross and Blue Shield are very strong from a network standpoint.



Can you cancel individual health insurance anytime?

Yes.  Insurance carriers will give you a rate based on the information provided on the application, telephone interview and/or the medical exam and you pay that rate up front.  If for any reason you want to cancel, you can certainly do that.  You will be pro-rated for that month and be given a refund.



Is dental covered under my medical health insurance plan?

Generally no.  Most health insurance plans do not cover dental expenses.  You have to make sure you read the benefit summary detail of the medical plan to see if it is covered.  Usually, you have to purchase separate dental insurance if that is something that you need.



Are prescription drugs covered under health insurance plans?

Generally yes.  Most health insurance plans cover drug benefits.  Make sure to look under the benefit details to see how much and which types of drug benefits are covered.  Prescription drug benefits are generally broken out between generic and brand name drugs.




What is group health insurance?

Group insurance is company sponsored plans that offer employees more competitive plans and rates than private insurance plans.  In California, companies with less than 50 employees also have some major advantages such as guaranteed coverage and no medical underwriting. 



Do all plans have maternity coverage?

Many private insurance plans actually do not offer maternity coverage.  Having a baby is a very expensive service for both the insurance company and the consumer.  If maternity coverage is necessary for your family, make sure to read the benefit summaries on each plan you are researching.  Rates will be a little higher but it is still cheaper than paying out of pocket. 



What is short-term health insurance?

Many private insurance carriers offer what is known as short-term health insurance.  These are insurance policies that range between 1 to 6 months in coverage and are there to protect against catastrophic or major health events.  Many people choose to get short-term health insurance when they are between jobs or when they need the "just in case" insurance policy for a shorter period of time.



Is individual health insurance coverage guaranteed?

No.  Many times when you apply for individual health insurance you will be subject to medical underwriting.  If the insurance carriers does not have enough information from the application, they can either request a phone interview to gather more information or even request a physical exam. 


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