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General Health

What is “Open Enrollment” and how does it work?

Open enrollment is the annual period when shoppers can enroll in new health insurance plans, switch plans, or take advantage of subsidies on health plans. If you don’t shop during open enrollment, you won’t have any options outside of special enrollment, Medicaid/CHIP, or paying a penalty. For 2017, open enrollment starts on November 1, 2016 and ends on January 31, 2017.  Call 877-860-6316 or stop by one of our offices – we will be happy to advise you on the plan that best meets your needs.

What does health insurance usually cover? Are there medical services that are typically not covered by health insurance companies?

Some typical exclusions to health insurance coverage include aquatic therapy, artificial insemination, chiropractic services, cosmetic services, custodial care, dietician services, disposable supplies, experimental and investigational services, hair loss and growth treatments, infertility services, and intermediate care. Even if you already have health insurance, Freeway may be able to find a cheaper plan for you. Call 877-860-6316 or stop by one of our offices – we will be happy to advise you.

What are the options for temporary medical insurance for visitors?

Visitors are not required by law to be insured. Only visitors with certain immigration status qualify to use the marketplace, such as U.S. citizens, U.S. nationals, and lawfully present immigrants.

Why is it illegal to not have health insurance in the United States?

The Affordable Care Act mandates health insurance as a shared responsibility for all Americans.

Your income level and family size are considered when determining whether you will receive free or subsidized health insurance. If you do not qualify for an exemption from health insurance or you do not receive free health insurance, you will be assessed a tax penalty (if you have a health insurance gap of more than two months, or more than one gap in a tax year). Covered California insurance marketplace plans meet federal ACA guidelines and Freeway Insurance can help you find the best plan for your health and your budget.

What is a health insurance premium?

A health insurance premium is the monthly fee you pay to your health insurance company to provide health insurance services and keep your policy active.

What is cashless health insurance?

Members of Federally recognized American Indian or Alaskan Natives can enroll in zero-cost sharing plans. This means they do not need to pay-out-of pocket costs when receiving health services.

What are the most affordable health insurance plans available to a new, small business?

As a small business with fewer than 100 employees, you can provide health insurance to your employees with Covered California’s SHOP (Small Business Health Options Program). Freeway Insurance will help you to determine the health insurance tiers (bronze, silver, gold, platinum, and catastrophic) and the percentage you will pay toward employee and dependent coverage.  You can cover up to 100 employees and your business may even qualify for tax credits when you purchase health insurance with Covered California’s SHOP. Call 877-860-6316 or stop by one of our offices – we will be happy to advise you.

Is IVF generally covered by health insurance?

IVF (in vitro fertilization) is not covered under Covered California plans. Only services used to detect infertility are covered.

What medical services are not typically covered by health insurance companies?

Dental and vision care are not covered for adults, though children under age 19 are covered for these services. You can purchase separate dental and vision plans through Covered California if you wish to include these services in your health insurance coverage.

Weight loss surgery and weight loss programs are generally not covered unless you are morbidly obese.

Infertility treatments and elective cosmetic surgery/treatments are not covered.  Cosmetic surgery that is medically necessary is covered.

Long-term care and private nursing services are not covered. You can purchase additional insurance plans for these services if you wish.

If I’m an independent contractor who uses a 1099 tax form, what is the best health insurance for me?

For an independent contractor, Freeway Insurance recommends the Silver plan. This plan was designed to have a low monthly premium and still make out-of-pocket expenses affordable.

Health insurance prices depend on various factors including age, gender, where you live, and whether you smoke. Actual prices will vary depending on each individual, but health status is never a factor on rates. Call 877-860-6316 or stop by one of our offices – we will be happy to advise you.

Why do employers cover only part of my health insurance premiums instead of the full amount?

Significant increases in health insurance costs have made it difficult for employers to provide full insurance premium coverage to their employees and remain in business. Health insurance costs continue to rise and employers that offer health insurance generally offer it as a shared cost.

For entrepreneurs just starting out, what is the best type of health insurance?

If you are self-employed, Freeway Insurance can help you to select a plan that makes sense for your situation.

If you have employees, you can also provide health insurance to your employees with Covered California’s SHOP (Small Business Health Options Program). Freeway Insurance will help you to determine the health insurance tiers (bronze, silver, gold, platinum, and catastrophic) and the percentage you will pay toward employee and dependent coverage.  You can cover up to 100 employees and your business may even qualify for tax credits when you purchase health insurance with Covered California’s SHOP. Call 877-860-6316 or stop by one of our offices – we will be happy to advise you.

Can I cancel my health insurance plan without paying the premium if I never used the benefits?

Individuals purchase health insurance because accidents and illnesses are unpredictable. You may not have accessed your benefits, but if you had needed medical care, your health insurance would have been essential in saving you stress and financial hardship. If you cancel your insurance, you will not receive a refund. If you are uninsured for more than two months you will likely face tax penalties as mandated by the Affordable Care Act.

How can I obtain the best health insurance policy for me? How much is the cheapest Covered California plan?

Freeway Insurance can help you to choose the health insurance plan that works best for your health and your budget. The type of medical care you need is an important consideration when selecting a health plan. If you are in good health, a managed care plan (or HMO plan) can be cost effective. If you have a medical condition which requires visiting specialists regularly, a preferred provider organization, or PPO plan, may be best for you.  Freeway agents are trained to help you select a plan to meet your individual and family health needs. Freeway has partnered with some of the nation’s most trusted insurance carriers to offer you the highest quality health insurance. Our brokers are here to help you save money, and guide you to any free or low cost programs for which you may qualify.  Even if you already have health insurance, Freeway may be able to find a cheaper plan for you. Call 877-860-6316 or stop by one of our offices – we will be happy to advise you.

I am a 33-year-old female and I just found out I have an illness I need to take care of. I’d like to purchase insurance – can I do that now that I’ve been diagnosed? Is this a pre-existing condition?

Under the Affordable Care Act, health insurance companies cannot refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts. Under this law, health insurance companies also can’t charge women more than men. Freeway Insurance can help you to choose the health insurance plan that works best for you. Call 877-860-6316 or stop by one of our offices – we will be happy to advise you.

I have a very low income. Is there affordable dental and health insurance for someone like me?

Yes. Depending on your income, health insurance can be very affordable, or in some cases free. Dental insurance can be as low as $13.00 per month.

I am from Mexico, but I’m working in Los Angeles. My employer does not provide health insurance coverage. Where can I obtain coverage?

In order to obtain health insurance coverage, working immigrants are required to prove they are legally residing in the United States. Qualifying immigration status includes:

  • “Qualified non-citizen” immigration status without a waiting period
  • Humanitarian statuses or circumstances (including Temporary Protected Status, Special Juvenile Status, asylum applicants, Convention Against Torture, victims of trafficking)
  • Valid non-immigrant visas
  • Temporary resident status, LIFE Act status, or Family Unity individuals

Can I make changes to my dental or health insurance plan after “Open Enrollment” ends?

Dental plans, just like health plans, can only be purchased during open enrollment period. Dental coverage for adults is not an “essential health benefit” under the Patient Protection and Affordable Care Act.

If certain personal information changes during the year, you must report it. Changes to your address, family size, or income can affect whether you qualify for Medi-Cal or qualify for assistance with paying for your health insurance through Covered California.

Why do health insurance companies provide a short window of time for enrollment in a health plan?

Without an open enrollment period and a requirement to have coverage, many healthy people could forgo insurance until they became sick or injured and then purchase insurance only once they need to utilize it. This is why Open Enrollment is so important.

Outside the Open Enrollment Period, you generally can enroll in a health insurance plan only if you qualify for a Special Enrollment Period. You’re eligible if you have certain life events, like getting married, having a baby, or losing other health coverage.

  • Job-based plans may have different Open Enrollment Periods. Check with your employer.
  • You can apply and enroll in Medicaid or the Children’s Health Insurance Program (CHIP) any time of year.

Covered California

How do most consumers qualify for health insurance plan through Covered California? What is the “downside” to working with a Covered California insurance agent?

In order for consumers to receive financial assistance to help pay for their health insurance, they must go through Covered California (California’s healthcare marketplace). Freeway Insurance can help you to navigate the health insurance marketplace. Call 877-860-6316 or stop by one of our offices – we will be happy to advise you. Our services are complementary.

Is my doctor required to accept my health insurance plan if it was obtained through Covered California?

Most doctors and healthcare providers accept plans from Covered California. We recommend that you check with your preferred doctor before selecting a plan.

Is there a “cap” or restriction on the number of Covered California plans offered to consumers?

No. Everybody is welcome! Freeway Insurance can help you to navigate the health insurance marketplace. Call 877-860-6316 or stop by one of our offices – we will be happy to advise you. Our services are complementary.

Does California have its own healthcare marketplace?

Yes. California has its own marketplace. So far, 1,149,000 people have renewed their plans with Covered California.

Obamacare/Affordable Care Act

What are the benefits of choosing an employer health plan versus the private plans offered through “Obamacare” (The Affordable Care Act)?

If you have coverage through your employer, you might be able to change to a Marketplace plan. But you probably won’t qualify for a premium tax credit or other savings. As long as the job-based plan is affordable and meets minimum standards, you won’t qualify for any additional savings. Most job-based plans meet these standards.

What impact has the Affordable Care Act (“Obamacare”) had on health insurance companies?

  • Individuals can no longer be denied coverage due to pre-existing conditions.
  • Women can no longer be charged more than men for health coverage.
  • Children can stay on their parents’ health insurance plan until the age of 26.
  • Requires all insurance companies to meet 10 Minimum Essential Health Benefits.
  • Insurance companies can no longer place lifetime limits, and there are limits on the amount of money you pay out of your pocket.

Veterans

Do the VA benefits I currently receive meet the standards of the Affordable Care Act (“Obamacare”) or will I pay a penalty?

Yes. If you’re enrolled in (or are a beneficiary of) any of the programs listed below, you’re considered to have qualifying health coverage under the new health care law. This means you won’t need additional coverage.

  • Veterans health care program
  • VA Civilian Health and Medical Program (CHAMPVA)
  • Spina bifida health care benefits program
  • TRICARE

Maternity

I am pregnant and I do not have health insurance. What are my best options for gaining health coverage?

In California, there are several options for uninsured pregnant women to get health coverage. Eligibility for the different options depends on income level and citizenship or immigration status. As a pregnant woman, you may be eligible for both Medi-Cal and Covered California during your pregnancy and immediate postpartum, depending on your income.

These options include Covered California health insurance plans and the following Medi-Cal programs:

  • Presumptive Eligibility for Pregnant Women — temporary coverage up to 60 days.
  • Full-coverage Medi-Cal — no-cost coverage.
  • Pregnancy-related Medi-Cal — no-cost coverage.
  • Medi-Cal Access Program — low-cost coverage.

Can I add my pregnant wife to my employer’s group health insurance plan?

You might want to ask your employer if a family member can be added to your health insurance plan, but other options with Covered California are still available.

Do all the major insurance companies offer maternity coverage?

Yes. Both maternity and newborn care are part of the 10 Minimum Essential Coverages.

I currently have a high deductible health care plan under Obamacare. Can I switch to a lower deductible policy if I become pregnant?

Health insurance plans cannot be changed unless there is a special event or during Open Enrollment. Covered California does not require members to report a pregnancy. If you are an existing Covered California member, it is not necessary or recommended to report a pregnancy unless you are interested in other coverage options for pregnant women such as Medi-Cal or the Medi-Cal Access Program.

My girlfriend has just become pregnant. Can I add her to my existing Kaiser Permanente plan?

In most cases, no, you must be married to add her to your plan. Pregnant women without insurance may be eligible for Medi-Cal, which is based on income and household size.

Will I receive maternity coverage under COBRA if I quit my job? Will the coverage be the same as when I was employed?

Yes. COBRA is considered a Qualified Plan, meaning it falls under the 10 Minimum Essential Coverages. Freeway Insurance can help you to navigate the health insurance marketplace. Call  877-860-6316 or stop by one of our offices – we will be happy to advise you. Our services are complementary.

Immigrants

What are the steps a new immigrant should take to become insured?

First, an immigrant would need to find out if they qualify for assistance. Legal resident aliens qualify for health insurance through Covered California. Individuals who are not legally residing in the United States are exempt from the requirement to have health insurance.

Can an illegal immigrant sign up for a health insurance plan and how?

Both legal resident aliens and non-legal aliens can apply to determine if they are eligible for health plan options through Covered California or Medi-Cal. Immigrants who are not legal residents of the United States are not eligible to purchase a health plan through Covered California; however, they may be eligible for coverage through Medi-Cal.

Is health insurance available to immigrants who are elderly?

Both legal resident aliens and non-legal aliens can apply to determine if they are eligible for health plan options through Covered California or Medi-Cal. Immigrants who are not legal residents of the United States are not eligible to purchase a health plan through Covered California; however, they may be eligible for coverage through Medi-Cal, including the elderly.

Students

What types of health insurance are available to college students?

A “student health plan” is a special health insurance policy that colleges and universities make available to their enrolled students. Typically, the student health plan is different from the employer-sponsored group coverage that colleges and universities offer to their faculty and staff.

Is there a difference between the types of health insurance plans offered online and the types of plans offered through a licensed insurance agent?

There is no difference. Freeway Insurance can help you to navigate the health insurance marketplace. Call 877-860-6316 or stop by one of our offices – we will be happy to advise you. Our services are complementary.

Green card

What kind of health insurance can I get on a low income as a green card holder?

Legal resident aliens can apply to Covered California to determine how much assistance they can receive, or if they are eligible for no-cost health insurance through Medi-Cal.

Which kinds of health insurance plans are available to elderly folks who are still waiting to receive their green cards?

Elderly people waiting on their green card can apply to Medi-Cal and receive no cost insurance.

Seniors

I am 55 years old. Am I too old to sign up for health insurance?

No. Covered California’s age limit to receive insurance benefits is 64 years old.

My parents are 62 and 67 years old, respectively. Can they apply for health insurance if they are still waiting to receive their green cards? How do I find the best health care options for them?

Yes. People 65 or older can apply for Medicare or Medi-Cal coverage, regardless of their immigration status. Freeway Insurance can help you to navigate the health insurance marketplace. Call 877-860-6316 or stop by one of our offices – we will be happy to advise you. Our services are complementary.