Health Insurance FAQs
Frequently asked questions within the health insurance industry
How do agents get paid?
In the United States, health insurance is regulated at both the federal and state levels, creating a complex framework for oversight. The primary federal law governing health insurance is the Affordable Care Act (ACA), which established standards for coverage, prohibited discrimination based on pre-existing conditions, and expanded Medicaid eligibility. Additionally, the Centers for Medicare & Medicaid Services (CMS) oversees many federal health insurance programs, such as Medicare and Medicaid. States also play a crucial role by regulating private health insurance companies, setting their premiums, and ensuring that they comply with state-specific consumer protection laws. Moreover, state insurance departments monitor insurers to maintain financial stability and protect consumers. This dual system aims to balance accessibility, affordability, and quality of care while addressing the unique needs of different states and populations.
How is health insurance regulated?
When can I shop for a new health insurance plan?
Under the Affordable Care Act (ACA), U.S. citizens can shop for or change their health insurance plans during the annual Open Enrollment Period, which typically runs from November 1 to December 15. During this time, individuals can enroll in new plans or make changes to their existing coverage. A special enrollment period may be available for those experiencing qualifying life events, such as marriage, the birth of a child, or loss of other insurance coverage.
Outside of the Open Enrollment Period, U.S. citizens may explore private market options or short-term health plans, which can provide temporary solutions, but these do not necessarily offer the same protections as ACA-compliant plans. It’s essential for individuals to review their options carefully and ensure they meet their healthcare needs while staying within budget.
Health insurance brokers get paid through commissions from the insurance companies whose products they sell. When a broker assists a client in selecting a health insurance plan, the insurance company pays the broker a percentage of the premium for the policy sold. This commission structure allows brokers to offer their services at no direct cost to clients, as they earn their income from the insurers.
How can I check to see if I qualify for financial assistance?
HealthCare.gov is the official website of the federal health insurance marketplace, where individuals can find resources and information about available healthcare programs.
>Browse plans and costs
>Enter zip code
>Enter household info (Age, gender, annual income)
>View plans
The site also offers a step-by-step guide to help users assess their eligibility for programs like Medicaid and the Children's Health Insurance Program (CHIP). Applicants can fill out a Marketplace application online to see if they qualify for lower costs on health coverage. It's also advisable to gather necessary documents, such as tax returns and income statements, to streamline the process. For further assistance, individuals can contact local health offices or certified enrollment counselors who can provide personalized guidance based on their specific circumstances.