Here is a list of the most frequently asked questions about health insurance from our clients. We’ve divided them into categories to make it easier for you to find the question and answer you’re looking for.Click on the questions to see the answers.
If you don’t find what you’re looking for, use the comments below to give us your question and we’ll add that to the list. This is intended to be a growing page.
Glossary
[jaccordion size=”normal” theme=”smoothness” active=”*” ]Co-Insurance
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Once you reach the deductible you begin sharing costs with the insurance company. The cost sharing is called co-insurance. Typically you will pay 10% to 40% and the health insurance company pays the rest.
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Co-Pay
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The amount you pay for office visits and medical expenses that are not subject to the deductible.
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Deductible
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The amount you are required to pay before the health insurance company begins paying for part or all of your medical expenses.
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Negotiated Rate
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An insurance company payment, to a doctor or facility such as a hospital, for services rendered to you. This rate is usually much lower than the retail cost of the same medical service.
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Out-Of-Pocket Maximum
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The maximum amount you will pay before the insurance company pays 100 percent for all further medical expenses.
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General Health Insurance
Why are my kids in Medi-Cal?
Is Medi-Cal a good health plan?
What does Medi-Cal cover?
How do I get my children out of Medi-Cal?
Health Saving Account Questions
General
[jaccordion size=”normal” theme=”smoothness” active=”*” ]What is a Health Savings Account (HSA)?
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An HSA is a tax deductible, tax deferred account that can be used to accumulate money to pay for health care expenses. Withdrawals from an HSA to pay medical expenses are tax free.
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Who can open an HSA?
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Anybody with a high deductible health insurance plan can start an HSA, and make contributions, as long as they meet the following requirments:
- they have a HSA compatible high deductible health plan
- they don’t qualify for Medicare benefits
- they aren’t clained on someone else’s tax return
- they aren’t covered by a second health plan that is not HSA compatible
Why high deductible health insurance?
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With these insurance plans you will pay for all medical expenses until you reach the plan deductible. Because of this, you will be a better shopper for health care needs. Thereby reducing your out-of-pocket expenses.
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Are there HSA management fees?
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Potentially. HSA’s are typically held at financial institutions such as banks, credit unions, or companies set up to act as HSA Administrators. These providers have the ability to charge monthly fees, administrations fees, custodial fees, and fees for specific activities. You should ask to get a copy of the HSA account fees before you decide to keep your money at any specific institution.
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What happens to my HSA balance if I can no longer contribute new money?
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You can keep the money in your HSA account, and continue to use it to pay for your medical expenses, or let it grow for future needs once you reach retirement.
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Contributions
[jaccordion size=”normal” theme=”smoothness” active=”*” ]What are the eligibility requirements for contributing to an HSA account?
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To be able to contribute to an HSA account you must meet the same requirements as shown above for “Who can open an HSA?”
- they have a HSA compatible high deductible health plan
- they don’t qualify for Medicare benefits
- they aren’t clained on someone else’s tax return
- they aren’t covered by a second health plan that is not HSA compatible
How much can be contributed to an HSA?
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The amount that you can contribute to your HSA changes each year. The current limits are shown here.
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How is the contribution limit determined?
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The contribution limits are determined each year by the IRS based upon how much the Consumer Price Index (CPI) went up the previous year.
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Are their income limits that prevent contributions?
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No. Anybody that qualifies to have an HSA plan can make contributions regardless of their income.
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What is the deadline for making my HSA contribution?
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You can make yearly contributions to an existing HSA until April 15th of the following year. You can also start an HSA before April 15, and make contributions for the previous year, provided that you had an HSA-compatible health insurance plan in place by Dec 1st of the prior year.
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Maternity Insurance
[jaccordion size=”normal” theme=”smoothness” active=”*” ]Can I be declined because I’m pregnant?
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No. In the past, insurance companies would decline to offer coverage if you applied while you were pregnant, because it was considered a pre-existing health condition. Today you can not be denied coverage due to pregnancy. Individual, family, exchange, and company sponsored health plans must accept you. You will pay the same price for your health plan as any other man or woman that lives in your area and is the same age as you.
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How do I get medical insurance if I’m pregnant?
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Sign up for coverage through your employer, or shop for coverage in the individual/family health insurance market. For information about the best health plans for prenatal and delivery costs,
click here.
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Will I get identical coverage in any state or any plan I select?
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Probably not. Each state is allowed to set their own standards for the plans offered within that state. All plans must meet a minimum standard for care, but additional benefits are a state by state decision.
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Is prenatal care fully covered by my health plan?
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In Califonia, prenatal care is considered a preventive service. Standard prenatal office visits and lab tests will be covered at no cost to you. However, if any abnormal results occur, you may be required to pay for non-standard prenatal care as a result.
Standard prenatal care includes the following:
- Prenatal office visits
- Prenatal lab tests
- Testing and counseling for sexually transmitted diseases, including HIV
- Testing for Rh incompatibility
- Folic acid supplements (with a prescription), to help protect your baby from birth defects
- Testing for gestational diabetes
- Screening and help to quit tobacco use
- Breastfeeding counseling and equipment
- Birth control after you’ve had your baby
Affordable Care Act Health Plans
Open Enrollment
Special Enrollment
Dental Insurance
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