Frequently Asked Questions and Answers About Health Insurance

Health insurance is a service where an Institution takes care of your health-related bills. In return for a fee, an insurance company promises to cover a part or all of a person’s medical expenses. Health insurance typically covers the medical, surgical, prescription medication, dental costs, etc. Insurance may cover or the healthcare provider may pay directly for expenses incurred due to sickness or injury.

Medicaid generally provides certain dental care for anyone over the age of 21; however, in some jurisdictions, this coverage is limited to emergencies only. Dental care for Medicaid-eligible children is a federal requirement in every state.
Adults enrolling in the ACA’s Medicaid expansion receive different benefits than other participants in a few states. In these states, a 55-year-old with Medicaid expansion coverage may not have dental coverage, although a 70-year-old qualifying for Medicaid based on age and financial conditions may. (The inverse situation is also feasible, in which a state may provide dental care to expansion enrollees but not to other adults.)

Possibly, but it’s also possible that this isn’t the case. It’s difficult, but that’s to be expected when dealing with health insurance and health care reform in general.

Employer-sponsored health insurance is the norm for most Americans under 65. However, not every company provides group health insurance. So, even if you don’t work for yourself, you may need to get individual or family health insurance for a variety of reasons.
If you’re lucky, you can find solutions that are both affordable and effective. Employer-sponsored health insurance isn’t always available in these situations, but there are still ways to get reasonable, comprehensive coverage.

For individuals who are in good health, the cost of the premium is the most essential consideration while shopping for health insurance. If you’re primarily concerned about money, you shouldn’t base your decision solely on price (as opposed to factors such as provider networks, drug formularies, and quality ratings).

Beginning January 15, 2022, the cost of up to eight at-home COVID tests will be reimbursed by your ACA-compliant health insurance plan. Although the Biden administration discussed and announced the rule’s introduction in December 2021, the official guideline was only released on January 10 of this year.

The revised regulations will make at-home COVID testing more widely available. COVID tests are still in short supply, and insurers have only four days to comply with the new requirements, according to a statement from the Blue Cross and Blue Shield Association. To complicate matters further, over-the-counter COVID tests necessitate the development of new billing codes and reimbursement systems, and insurance rarely covers over-the-counter purchases.

As a result, there may be some supply issues at local and online stores, as well as issues with how health plans administer the program for their members, early on. Meanwhile, health plan members may be confident that the amended coverage guidelines will provide them with free at-home COVID testing for the duration of the pandemic emergency, albeit with some potential delays in the beginning (the pandemic emergency period has been extended numerous times, most recently through mid-April 2022).

Some Americans can enroll in private health insurance through the marketplace/exchange for as little as $0 per month. Many people who are now uninsured may be able to sign up for a marketplace insurance plan at a lower cost than they anticipated thanks to the Affordable Care Act.

The American Rescue Plan has increased the availability of zero-premium insurance programs (ARP). We also don’t know if the ARP’s subsidy enhancements will be extended after 2022.

Although the ARP’s subsidy increases have not yet been extended, sure participants already had access to zero-premium plans. They will continue to do so if the ARP is not developed.

Sure, but when Policymakers recognized that healthy people would be critical to the program’s effectiveness when it was established because insurance only works if there are enough low-cost enrollees to offset the higher-cost enrollees. As a result of this individual requirement, the law included a shared culpability clause.

Persons who did not have minimum essential coverage would be subject to a tax penalty unless they were exempt from the shared responsibility provision.

There’s no reason why you can’t get General Insurance via the internet. ICICI Bank, for example, is one of a number of insurance companies that allow customers to apply for General Insurance coverage online. There are a lot of advantages to purchasing General Insurance online, including the fact that it is both safe and convenient. One of the benefits of purchasing insurance online is the ease and speed with which the application process may be completed, along with the lower costs and accessibility of the policy documents.

There are a number of events that are covered by travel insurance. From one plan to the next, the actual number of occurrences is different. However, the following is a general overview of what a Travel Insurance policy will cover:

Personal accident cover

Hospitalization expenses

Trip delays, cancellations, or interruptions

Loss or damage to baggage checked-in

Loss of passport 

Accidents experienced when participating in adventure sports may not be covered by several types of travel insurance due to excluding clauses. Make sure you read the policy’s terms and conditions to find out exactly what situations are covered.

Non-Life insurance is what general insurance is all about. In addition to life insurance, this policy provides coverage for other valuables. The following are some examples of General Insurance, each with its own specifics:


Health Insurance ensures the health of the policyholder

Home Insurance, which covers residential properties

Vehicle Insurance, which covers automobiles, cars, and other kinds of vehicles,
depending on the specific terms of the policy

Travel Insurance, insures the policyholder against several mishaps/accidents that could occur during travel

Expenses incurred as a result of medical treatment or surgery are covered by health insurance coverage. The policyholder must stay in the hospital for at least 24 hours straight in order to get the health plan’s benefits. To receive benefits from several outpatient operations, you must first be admitted to the hospital.

A cashless health insurance policy allows you to receive care at a network of participating hospitals without having to pay a fee. Policyholders can take advantage of this benefit by obtaining approval from the insurance company/assigned TPA in advance of scheduled procedures or within the allotted time frame in the event of emergency surgery. In order to receive cashless treatment at a network hospital, policyholders must present health cards issued by their insurers, along with valid photo IDs, to the hospital or TPA staff.

TPAs, also known as third-party administrators, play the role of intermediaries between policyholders, medical institutions, and the insurance companies that cover them. With the assistance of a TPA, which acts as a liaison between the policyholder, the hospital, and the insurance company, an insurance claim can be quickly and painlessly settled.

A network hospital is a hospital or health unit that has a direct or indirect relationship with a TPA or health insurer. Depending on the conditions of the policy, the policyholder may be eligible for cashless hospitalization if hospitalized in one of the insurer’s network hospitals.

When you are young and healthy, it is always a good idea to purchase a health insurance policy with an acceptable sum insured. Here are two reasons to purchase a health insurance policy.

As a first and foremost consideration, you should consider it for your own mental well-being. You won’t have to worry about the doctor’s fee or other medical costs if you have health insurance. In addition, any catastrophe or accident can happen to anyone at any time; it can happen anywhere.

Saving money on premiums is possible when you purchase health insurance when you are young. Because the likelihood of falling ill is lower while you are younger, you may afford to purchase a health insurance policy with a sufficient insurance sum at the lowest possible premium rate.

Select the plan: the first term of each academic year, via My Buckeye Link before the Select/Waive deadline.

Be enrolled in eligible courses: every fall and spring, and if at all possible, enroll in such classes before the start dates of the coverage period are reached; (see dates here). If you want student health insurance, you must be enrolled in courses that meet credit hour and course requirements.

Verify that the fee for student health insurance is listed on your Statement of Account. Your insurance coverage is not active if it does not show up.

Pay your student health insurance policy.

Yes. Because your parents are not eligible for Medicare, they can purchase a private plan through the exchange (marketplace) and may be eligible for cost-sharing reductions and premium subsidies based on their income.

Section 1882 (d)(3) of the Social Security Act specifies that it is illegal to sell private health insurance to someone who is eligible for Medicare, however, the restriction only applies to Medicare eligibility, not age. And, as your question shows, not everyone over the age of 65 is eligible for Medicare.

You can have the best of both worlds: a broker can assist you in enrolling through the exchange, providing individual assistance and recommendations while also letting you get any Obamacare subsidies for which you qualify.

Travel insurance is available from a variety of insurance companies, and plans are available for coverage in your own country or when traveling abroad, including to the United States. Most health insurance brokers can help you select coverage that meets your requirements.

On November 1, 2021, open enrollment for 2022 health coverage began nationally (in New York, it began on November 16). It expired on January 15, 2022, in the majority of states (and in most states, enrollments completed between December 16 and January 15 took effect on February 1).

The COVID-19 pandemic has had a significant influence on the world in recent years. “How will my health insurance cover the coronavirus?” is a popular query.

The quick answer? It all depends. With the exception of Original Medicare, health insurance in the United States varies widely based on where you reside and how you receive coverage. There are 51 different sets of state insurance standards, separate rules that apply to self-insured group plans (which are not governed by the states), and 51 different Medicaid/CHIP systems (including the District of Columbia).

Short-term health insurance policies, designed for healthy individuals and families, provide an inexpensive safety net for consumers who, owing to changing circumstances, may find themselves temporarily without comprehensive health insurance or unable to purchase full coverage.

These plans are appealing to consumers who do not qualify for premium subsidies in the health insurance marketplace, or who missed open enrollment and are now without coverage. This includes those who are between jobs, retiring before reaching Medicare eligibility, or who have already enrolled in alternative insurance coverage (such as an employer-sponsored plan or an ACA-compliant individual market plan) and are waiting for it to take effect.

A short-term health plan can also be utilized to bridge a coverage gap if you are newly employed and have a three-month waiting period before being eligible for your employer’s health benefits plan.

In the 12 states that have declined to expand Medicaid, over 2.2 million people are currently without coverage. Their household incomes are below the federal poverty line, so paying full price for health insurance is most likely out of the question.

You can obtain a short-term health plan as long as you pass the minimal medical underwriting involved in most short-term health plan applications (a very brief set of yes/no questions about major medical events). However, keep in mind that the plan would almost certainly exclude any pre-existing medical condition, even if it is not specified in the list of health concerns on the application.

Enrollment is open all year, though medical underwriting is required. As a result, you can enroll or change plans whenever you want, rather than waiting for an open enrollment period.

Short-term policies allow healthy applicants to obtain quick individual and family coverage, with plans that can take effect as soon as the next day. If you know how many days you’ll need to be covered, your insurer may let you make a single payment for the whole coverage period.

Monthly premiums for short-term health insurance vary greatly depending on where you live, your age, and the insurance company providing coverage. Depending on the conditions, they can start as low as $100 each month.
Although premium subsidies are not available for short-term policies, they are significantly less expensive than ACA-compliant major care plans if you are not eligible for one.

Short-term health insurance policies are intended to cover at least a portion of the expense of unforeseen medical events that are unrelated to a pre-existing condition. In general, the plans will cover inpatient and emergency care, surgeries, different outpatient services, lab work, and imaging. Some short-term plans cover inpatient prescription medicines, but they are significantly less likely to cover prescriptions picked up at the drugstore.

Although short-term plans are available in the majority of states, there are 11 states where they are not offered at all.

States where short-term health insurance coverage will be unavailable in 2022:

California
Colorado
Connecticut
Hawaii
Maine
Massachusetts
New York
New Jersey
New Mexico
Rhode Island
Vermont

In some circumstances, this is due to state regulations openly prohibiting them, while in others, state requirements are so stringent that insurers have chosen not to market short-term policies. (In Washington, short-term plans with January effective dates are not sold between November 1 and December 15, but they are available elsewhere.)

Short-term plans are available in the remaining states, however rules and availability vary greatly. (Select your state from the dropdown menu above to learn more about how short-term plans are governed in your state.)

It all depends. There are no penalties for not including pediatric dental coverage in your policy. In addition, in most exchanges, you can purchase a plan without including pediatric dental coverage. However, unless you obtain a kid’s dental from another source, carriers are compelled to include pediatric dental off-exchange.

Some do, while others do not. They are not required to, and in more than half of the states, health insurance plans sold through the exchange/marketplace are not permitted to cover abortions unless there is rape, incest, or the mother’s life is in danger.

Nearly all plans cover maternity.

One to two years after the effective date the insurance policy was granted is the contestability period. During this time, the insurance company has the authority to investigate the insurance policy and decide whether or not to pay the claim that was submitted by the insured.

As compared to life insurance policies, traditional savings plans like bank FDs, NSCs, and PPFs have shorter maturation periods. As a result, these types of savings strategies don’t provide prospects for comprehensive financial planning.
If a policyholder dies before the end of a payout term, the policy’s beneficiaries receive the full amount of the policy, as well as any bonuses that may have been accrued. As a result, having life insurance provides peace of mind. Even if the policyholder dies before his or her payment period is over, a life insurance policy will pay out the sum insured and any bonuses that may have been accrued. As a result, the person and their loved ones are more protected. Compared to other types of savings, an insurance policy provides a higher level of financial stability.

The appropriate quantity of coverage is determined by a number of criteria, including your financial circumstances, family situation, health, and age. Some experts advise buying life insurance worth eight to fifteen times your annual salary.

Others advocate a more tailored approach that takes into account your current salary as well as any lingering debts, remaining mortgage payments, and college tuition obligations for your children.

A beneficiary is the designated individual on your insurance policy who will be compensated by the insurer in the event of your demise.

If you have a health insurance plan in the individual market, either on or off the exchange, you can probably just let it renew for the next year without doing anything during open enrollment.

No, not since 2016. As far back as I can remember the response was almost always “no”.

If you’re healthy – or sick – and have some money saved or plan to save some in the next year, a high-deductible health plan may be worth considering (HDHP). Yes, that’s a broad statement, but HDHPs can work effectively for people in a variety of scenarios – they’re worth investigating even if your medical expenditures are high!

No. Infertility treatment is not one of the ten essential benefits, and it is not required by the ACA or any other federal law. But that doesn’t imply it’s never covered because states can have restrictions that go above and beyond the federal government’s basic requirements.

Pediatric dental care is one of the ACA’s essential health benefits. However, there is no requirement that adult dental care is covered.

Never fear, everyone is entitled to free preventative treatment under the Affordable Care Act. Certain services are available to all people, others to children, and a special subset to women. HHS has indicated why there was a unique need for mandatory benefits related to women’s health – for the most part, it’s a preventive treatment for illnesses or ailments that solely – or mostly – affect women.

If you do not qualify for subsidies, you can shop anywhere except in DC outside of the exchange (there is no off-exchange market in DC). Even if you qualify for subsidies, no one is compelling you to use the exchanges. You can shop off-exchange if you want, but you won’t be able to claim the subsidies (a tax credit) either upfront or on your tax return. And, until the end of 2022, you may be eligible for a premium tax credit even if you were not in previous years.

There are 18 entirely state-run health insurance marketplaces (SBMs) for the 2022 plan year, three state-based marketplaces using the federal platform (SBM-FP), six state-federal cooperation marketplaces, and 24 totally federally-run marketplaces.

FSAs and HSAs are both tax-advantaged accounts that allow consumers to save money for eligible medical expenses, but they differ in significant ways. The ACA imposed new limitations on FSAs and HSAs.

It could be, or it could be a private exchange. The state health insurance exchanges were created as part of the Affordable Care Act, or Obamacare, and went live in 2014. (Massachusetts and Utah have exchanges that predate the ACA.)

It’s highly doubtful that this individual had a truly significant medical plan. Individual market deductibles of $50 vanished long before the ACA. It’s difficult to say what this person’s plan was without seeing further specifics. It could have been a set indemnity plan with a $50 deductible, similar to the pre-ACA plan we profiled several years ago.

The deductibles and out-of-pocket maximums on Bronze plans are, indeed, rather hefty. The maximum out-of-pocket (OOP) allowed on any plan for 2022 is $8,700 for a single individual. And Bronze Plans typically include out-of-pocket limits that are at or near this level.

But, in addition to the premium tax credit subsidy, you need to be aware of another subsidy (and premium tax credits are larger than usual in 2021 and 2022, thanks to the American Rescue Plan). It’s known as a cost-sharing reduction or cost-sharing subsidy.

If you do not pay your payments and the grace period for plans available through a health insurance marketplace runs out, you will lose your insurance coverage. Depending on whether you receive subsidies and have paid at least one health insurance premium so far this year, the grace period is either one month or three months long.

In general, if you did not enroll in a plan by the conclusion of open enrollment, your coverage alternatives are severely limited. Most states’ open enrollment period for 2022 coverage ended on January 15, 2022, however, Idaho’s ended in December, and some states prolonged enrollment until the second part of January. The open enrollment period extends beyond the exchange.

It depends on where you reside and how much medical treatment you use annually. However, it is equally crucial to realize that if you do not purchase ACA-compliant health insurance, you may miss out on the financial aid provided to most marketplace enrollees.

A health savings account (HSA) may be exactly what the doctor prescribed. When used appropriately, this novel method of health insurance can give significant benefits that can help you maintain a healthy personal and financial life.

The IRS and the health insurance marketplaces utilize an ACA-specific version of modified adjusted gross income to determine subsidy eligibility (MAGI). Even if only one spouse applies for insurance in the exchange, MAGI is based on household income.

Remember that subsidy eligibility is determined by income in relation to the poverty threshold. Although your overall family income certainly exceeds your wife’s wage alone, the poverty level for a household of two exceeds the poverty level for a household of one. So, while your income is considered when evaluating whether she is eligible for a subsidy, you are also considered as a member of the household when determining how the household’s income compares to the poverty line.

That is absolutely possible.

They can both be beneficial in terms of lowering your total dental costs, but they differ greatly in terms of the benefits you receive and the cost of the coverage.

A discount plan normally requires a monthly or annual cost, while some discount programs are free of charge. When you display your card when filling a prescription, the pharmacy pays you a percentage reduction on the drug’s cost.

Prescription medication insurance works in the same way as medical insurance. You (or your employer) pay a premium, and then when you fill a prescription, you pay a copay (or deductible or coinsurance).

Short-term health insurance policies might be a low-cost choice for people who just require short coverage. People without a qualifying event have relatively few options for acquiring new health coverage outside of the Obamacare annual open enrollment window; in general, short-term insurance will be their best option.

For adults, it is entirely dependent on the amount of dental care required throughout the year. However, the Affordable Care Act has implemented limits that limit out-of-pocket costs for dental care for children.

Yes (with the exception of some self-insured student health plans). Student health insurance plans must cover preventative care and cannot charge copays for certain suggested preventive services.

The decision to get dental coverage is not necessarily as clear-cut for people who purchase their own insurance as it is for those who purchase health insurance.

Sure.

It is, indeed, legal. Employers with 50 or more employees are required by the ACA to provide coverage to employees and their children (up to the age of 26), but not spouses.

Yes, however, he is not eligible for a subsidy to help pay for health insurance through the marketplace. You cannot acquire a subsidy to assist pay for individual coverage if you have access to an employer-sponsored plan that is deemed affordable.

Probably likely not. You are not eligible for a government subsidy to help you buy coverage in the exchanges if your employer’s insurance is considered affordable and provides minimum value (ie, is comprehensive).

Yes, the ACA makes coverage available to you, and you may be eligible for financial assistance to reduce the cost of your coverage and out-of-pocket expenses if you require medical treatment.

The fundamental goal of the Affordable Care Act was to remove barriers to insurance coverage for most Americans who were uninsured due to pre-existing conditions or cost concerns.

Yes, because the tobacco surcharge under the ACA appears to make sense – particularly to nonsmokers – because it helps to disperse the increased healthcare costs of smokers across only the smoking population rather than the entire population.

If you are the uninsured heart attack patient who comes to the ER, the rest of us will foot the price. The cost of “uncompensated care” is passed on to patients by hospitals.

Regardless of where you get your health insurance, you (and the IRS) will receive a tax form each year from your employer, insurance provider, or exchange indicating that you had coverage the prior year. The information on these forms is utilized to complete your tax return and reconcile your premium subsidy on your return, if applicable.

When a patient arrives at the emergency room who is uninsured and unable to pay for his care, the staff is merely required by law to do a medical screening test and, if emergency medical problems exist, to “give stabilization therapy.”

A cost-benefit analysis will be required.

You are most likely qualified for Medicaid when you are unemployed, as mentioned further below. Furthermore, if you receive unemployment benefits at any time during 2021, you are eligible for a $0 premium silver plan in the marketplace, with substantial cost-sharing reductions built in.

Yes, the penalty varies based on whether the employer provides no coverage at all, or provides coverage but does not provide minimum value and/or is not reasonable.

No, unless you plan to hire at least 50 full-time equivalents (FTE) workers. Enterprises with less than 50 full-time equivalent employees (about 96 percent of all businesses in the United States) are not required to provide health insurance to their employees.

Since 2014, all new individual and small-group plans have included essential health benefits (EHBs), and there are no dollar limits on lifetime or yearly benefit maximums for these programs. Limitations such as a cap on the number of visits for a specific benefit such as physical therapy covered by the plan can still be used by insurers, but there can be no cost limits for essential health benefits.

Yes, it has been easier to obtain individual health insurance since the implementation of the Affordable Care Act (ACA).

Anyone can sign up for an exchange plan. However, your eligibility for a subsidy is determined by the cost of your group plan and the quality of the coverage.

You can always choose more than one health insurance plan during open enrollment as long as you execute the final plan change by the end of the period

Unless you have a qualifying event later in the year, absolutely.

In most circumstances, your health insurance coverage will not begin immediately.

It could be a qualification event. It is dependent on whether the health plans accessible in your new area are the same as the ones in your present area.

Yes, you can purchase insurance through the exchange during open enrollment and discontinue your COBRA coverage. You can cancel your COBRA coverage once you’ve registered in a plan for January. Your household income determines whether you are eligible for a tax credit.

Yes. Your Social Security income is factored into the subsidy eligibility computation.

You are not required to continue your COBRA plan unless you wish to.

In general, yes. In most circumstances, you must be a resident of a state in order to apply for insurance in that state.

Yes. The IRS concluded in 2012 that Medicare insurance premiums could be counted. Medicare premiums for the self-employed individual, as well as his or her spouse, dependents, and children under the age of 27, are deductible under the rule.

Exchanges, employers, and health insurance firms all use a different form to report their employees’ health insurance coverage to the Internal Revenue Service. There are also two forms linked to health insurance that some taxpayers are required to fill out when they file their taxes.
Consult a tax adviser or the Volunteer Income Tax Assistance Program if you have particular questions regarding your situation.

Yes, it is possible. In general, most people don’t wait, but certain people who have the money to pay full-price premiums throughout the year may find it advantageous to do so, especially if their income is uncertain.

Yes, if you’re self-employed. If not, it will be determined by how much you spend on medical expenses during the course of the year.

If you are self-employed, you can normally deduct the entire amount of premiums paid without having to itemize your deduction.

A special enrollment period is triggered by the loss of existing coverage, as long as it is minimum essential coverage. As a result, your son will be able to enroll in a plan with an effective date of August 1.

In general, no, yet it may be conceivable depending on the circumstances.

The individual mandate, which forces most Americans to keep health-care coverage, remains in place. However, there is no longer a penalty for failing to comply with the individual mandate beginning with the 2019 tax year.

Except that grandfathered group plans must now allow adult children to stay covered until the age of 26, regardless of whether they have other work coverage.

Yes, despite the fact that institutions with religious objections to contraception are not compelled to include contraceptive coverage in their student health plans.

Yes, in general. However, there was a one-time exception for 2020 coverage.

This can be a complicated scenario, and our response is designed to provide an overview of how the subsidy computation works; if you have questions regarding your unique case, always seek the advice of an experienced tax professional.

You should consult with an accountant. They are trained to identify areas where you may be missing out on deductions and tax breaks, so the money you spend hiring one will be well spent.

A premium subsidy has nothing to do with how many hours you work.

Both are possible. The amount of the subsidy is determined by the cost of a silver plan, however, it can be used to purchase a Platinum policy – or a Bronze or Gold coverage. The subsidy is applicable to any metal level, on-exchange plan excluding catastrophic policies.

You are right that your household income would qualify your family for a subsidy if you did not have access to any other coverage. However, eligibility for subsidies is also determined by access to group health insurance. So the fact that your family has group health insurance will be taken into account, and eligibility will be determined by whether or not that coverage is deemed “cheap.”

The federal poverty level (FPL) is a frequent term for the federal poverty criteria issued by HHS each year.

It is defined as a certain level of income that is used to assess eligibility for different income-based governmental programs such as Medicaid, premium tax credits, and cost-sharing reductions.

The federal poverty level is used to determine eligibility for Medicaid and CHIP (the Children’s Health Insurance Program), ACA premium tax credits and cost-sharing reductions, and Medicare savings programs (MSPs).