Frequently Asked Questions for Individual Health Insurance and Medicare


Health Insurance Basics

Do my spouse and I have to be on the same plan?

You and your spouse can purchase separate, different health insurance plans. However, your subsidy is calculated on combined income only if you purchase the same plan. Otherwise, it’ll be based on your income alone.

What if I only want to buy insurance for my children?

You can purchase separate health insurance for your children, but you (and your spouse, if you have one) will still be subject to paying the tax penalty. However, if you have qualifying health insurance, you won’t be subject to the penalty.

Should I apply for a plan or a subsidy first?

The first step should be to apply for a subsidy, so you can apply that tax credit to whatever policy you choose to purchase.

What is a PPO?

With a Participating Provider Organization (PPO), you will use the company’s network of hospitals and doctors, who are contracted at a discounted rate to provide services. A PPO generally won’t make you choose a primary care physician, but you will have an annual deductible and co-payment.

What is an HMO?

A Health Maintenance Organization (HMO) offers less choice in hospitals and doctors than other types of plans. You’ll need to choose a primary care physician (PCP), whom you will see for most of your healthcare needs. Your PCP will also have to refer you in order to see a specialist; however, you won’t pay a deductible and copayments tend to be low.

What is a POS?

A Point of Service (POS) plan combines features of an HMO and PPO. You’ll choose a PCP, but these services won’t be subject to a deductible and preventive care is covered.

Health Insurance Costs

What is an Obamacare subsidy?

A subsidy is a tax credit, providing a “discount” for purchasing health insurance on the Marketplace. You have to qualify for the subsidy, and the guidelines generally change every year. Contact us to find out if you qualify for a subsidy.

How can I know if I am eligible for a subsidy?

The best way to know if you are eligible for a tax credit is to apply for one.
Here are some of the qualifications required:
Your household income must be between 100 and 400 percent of the federal poverty level.
You must be a U.S. citizen, national or legally here in the U.S.
You can’t have access to health insurance coverage through an employer or other option.
You can’t be incarcerated.

Will my HSA work with Obamacare?

Your Health Savings Account (HSA) will still work with Obamacare; however, you can’t use it to purchase over-the-counter medications, and if you withdraw funds from it before you turn 65, you’ll be penalized at a higher rate: 20 percent.

If I don’t have health insurance, what penalty will I pay?

Only individuals who don’t have health insurance for longer than three months in a given year are required to pay the tax penalty. The only other factor that will exempt you from the penalty is if you qualify for an exemption.

In 2017, for example, you would’ve either had to pay a flat fee, for example $695 for an adult (adjusted for inflation), or 2.5 percent of your total household adjusted gross income. Check with your health insurance provider.

Is COBRA still available?

Yes. If you lose your job, you can stay on your health insurance plan through your employer for as long as 18 months. However, you don’t have to stay on COBRA if you want to purchase health insurance through the Marketplace, and vice versa.

Why do I have to divulge my household income to apply for health insurance through the Marketplace?

To determine if an individual qualifies for a subsidy, the government needs to know your Modified Adjusted Gross Income (MAGI) when you apply.

To calculate your MAGI, look at your most recent tax return and find your Adjusted Gross Income (AGI). Then, make any changes to this number that you expect for the year that could increase or decrease your total income. That will give you an idea of whether you will qualify in the upcoming enrollment period.

Renewing my Health Insurance

Do I have to purchase health insurance next year?

Yes, most Americans will be required to have health insurance coverage that meets minimum essential coverage guidelines. If you don’t have coverage, you could have to pay a tax penalty. The fine is calculated using a cost-of-living increase adjustment.

If I have a lapse in coverage this year, what will happen?

You can still apply for a health insurance policy during the open enrollment period, but only if you meet eligibility requirements. Otherwise, you’ll have to qualify for special enrollment in order to get coverage.

Will I be able to keep my doctor if I switch plans?

As long as your doctor remains on your provider’s plan, you’ll be able to continue seeing your doctor.

Will I have to pay more for health insurance every year?

Until carriers come out with their policies and pricing during open enrollment, it’s impossible to say with certainty what the prices will be. You can only estimate the costs. If you’d like to know more about what your health insurance costs might be, contact us today!

Signing Up

What’s the best way to purchase health insurance?

Signing up for health insurance on the Marketplace can be confusing. The average consumer doesn’t have the knowledge to navigate through the confusing terms and conditions and choose a plan. Working with an independent insurance advisor, you’ll get trusted advice from a professional who has your best interest at heart. And you’ll be able to call that expert again and again – and speak to the same person who is already familiar with your needs – whenever you have a question or at renewal time.

What plan is best for me?

There are four types of plans: Bronze, Silver, Gold and Platinum.
The costs that you’ll pay for deductibles, copays and coinsurance on each plan, on average, breaks down like this:
Platinum: You’ll pay 10% of the healthcare costs.
Gold: You’ll pay 20% of the healthcare costs.
Silver: You’ll pay 30% of the healthcare costs.
Bronze: You’ll pay 40% of the healthcare costs.

Work with a health insurance professional from InsureOne Benefits to weigh all your options before you select a plan.

Why should I work with InsureOne Benefits?

We are insurance professionals who know the ins and outs of the ever-changing health insurance landscape. But beyond that expertise, we care about our clients. We will treat you like family, offering you the same trusted advice we’d give our own family members. We’ll walk you through all the options, and help you find the best plan that suits your needs and your budget.

What does it cost to work with InsureOne Benefits?

Nothing! It’s absolutely free for you to call us or stop in and visit to chat or ask questions. No strings attached!