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Concord, NC 28025

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George Owens

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Kim Wexler

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James Cart

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George Owens

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Cradapibus at magna ultricies fringilla. Praesent elit libero, convallis vel feugiat sit amet, luctus dapibus ligula. Quisque commodo mi eu dolor consectetur,

Kim Wexler

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Cradapibus at magna ultricies fringilla. Praesent elit libero, convallis vel feugiat sit amet, luctus dapibus ligula. Quisque commodo mi eu dolor consectetur,

James Cart

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Frequently Asked Questions

Find clear answers to the questions you have about health insurance coverage.

What is the difference between ACA plans and private health insurance plans?

ACA (Affordable Care Act) plans are designed to provide comprehensive coverage and are regulated by federal standards to include essential health benefits, such as preventive care, maternity care, mental health services, and prescriptions. They also protect individuals with pre-existing conditions by ensuring they cannot be denied coverage or charged higher premiums. Additionally, subsidies are available for those who meet income requirements, making these plans more affordable for many families.

Private health insurance plans, on the other hand, are not bound by ACA regulations. These plans might offer fewer benefits or exclude certain coverages like maternity care or mental health services. They can be tailored to specific needs, such as catastrophic coverage or short-term plans, which are typically less expensive but may lack the comprehensive nature of ACA plans.

Choosing between ACA and private health insurance depends on your budget, health needs, and whether you qualify for subsidies. For those with pre-existing conditions or families needing broader coverage, ACA plans are often the best choice. Private plans might be better for those seeking temporary or minimal coverage. Discussing your options with a broker can help you make the best decision for your situation.

Can I get coverage for pre-existing conditions?

Yes, under the Affordable Care Act (ACA), health insurance plans are required to cover pre-existing conditions. This means insurers cannot deny you coverage, charge higher premiums, or exclude treatment for any condition you had before applying for a plan. This is a significant benefit of ACA plans, as it ensures comprehensive care for individuals with ongoing health issues.

Private health insurance, especially short-term or non-ACA-compliant plans, may not offer the same protections. These plans might exclude pre-existing conditions from coverage or impose waiting periods before they start covering related treatments. For those considering supplemental plans, like cancer or accident policies, it's important to review the policy details carefully, as some may have specific exclusions or waiting periods for pre-existing conditions.

If you have a pre-existing condition, it's crucial to discuss your needs with a knowledgeable broker. They can guide you toward plans that meet your health requirements and ensure you're protected. ACA plans are often the safest choice for comprehensive care, but supplemental plans may also provide additional financial protection for specific conditions.

What does a cancer plan cover, and how is it different from standard health insurance?

A cancer plan is a type of supplemental insurance specifically designed to help with the costs associated with cancer diagnosis and treatment. Unlike standard health insurance, which covers a broad range of medical needs, cancer plans focus exclusively on expenses related to cancer care. These plans often provide lump-sum payments or reimbursements for treatments like chemotherapy, radiation, surgery, and hospital stays.

Cancer plans may also cover non-medical costs, such as travel for treatment, lodging, or lost income due to inability to work. This financial support can be crucial, as standard health insurance may leave gaps in coverage, such as high deductibles, co-pays, or out-of-network costs.

While standard health insurance ensures access to doctors and hospitals for general health needs, a cancer plan acts as a financial safety net during a critical illness. It’s an excellent option for individuals with a family history of cancer or those seeking additional peace of mind. Consult with your broker to determine whether adding a cancer plan to your coverage portfolio makes sense for your situation.

Are dental and vision plans included in health insurance, or do I need to buy them separately?

Dental and vision coverage is not typically included in standard health insurance plans, including ACA plans. However, many insurance providers offer separate dental and vision policies or package them as add-ons to health plans. These plans cover routine care, such as cleanings, exams, fillings, glasses, and contacts, and may also include coverage for more significant needs, like root canals or corrective surgeries.

Some ACA plans may offer pediatric dental and vision benefits as part of their essential health benefits, but these do not extend to adults. For adults, purchasing standalone dental and vision plans is often necessary to ensure coverage for these services.

Investing in dental and vision insurance is worthwhile, as these out-of-pocket expenses can add up quickly without coverage. Brokers can help you identify affordable options that align with your needs and budget. Bundling these policies with your health insurance can simplify payments and sometimes lead to discounts, so it’s worth exploring your options.

How can I qualify for subsidies or financial assistance for an ACA plan?

Subsidies for ACA plans are based on your household income and family size relative to the Federal Poverty Level (FPL). If your income is between 100% and 400% of the FPL, you may qualify for premium tax credits, which lower your monthly insurance costs. In some states, individuals earning less than 138% of the FPL may also qualify for Medicaid.

To apply, you’ll need to provide income verification, tax information, and details about your household during the enrollment process. Subsidies are calculated to ensure you don’t spend more than a specific percentage of your income on premiums. Depending on your income level, you might also qualify for cost-sharing reductions, which lower out-of-pocket expenses like deductibles and co-pays.

Working with a broker can simplify the process of determining eligibility and selecting a plan. They can guide you through the application process, ensuring you maximize your savings and secure a plan that meets your health and financial needs.

Can I combine an ACA plan with supplemental insurance like accident or hospitalization coverage?

Yes, you can combine an ACA plan with supplemental insurance to enhance your coverage. Supplemental plans, such as accident, hospitalization, or critical illness coverage, provide additional financial protection by covering costs that standard health insurance may not fully address. For example, they can help with high deductibles, co-pays, or non-medical expenses like lost income during recovery.

An ACA plan ensures you have comprehensive coverage for essential health benefits, including preventive care and treatment for illnesses and injuries. Adding supplemental insurance can give you extra peace of mind, especially if you’re concerned about specific scenarios like a severe accident, hospitalization, or a cancer diagnosis.

When choosing supplemental coverage, consult with your broker to ensure the plans complement each other. They can help you avoid unnecessary overlap and tailor your coverage to your unique needs. Combining plans is a practical way to ensure your financial security while maintaining access to quality care.

What is Medicare, and who qualifies for it?

Medicare is a federal health insurance program primarily for:Individuals aged 65 or older.Certain younger people with disabilities.People of any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

What are the different parts of Medicare?

Medicare has four main parts:

Part A: Hospital insurance (covers inpatient care, hospice, and limited home health care).

Part B: Medical insurance (covers outpatient care, doctor's visits, preventive services, and medical supplies).

Part C: Medicare Advantage (an alternative to Original Medicare, offered by private insurers, combining Parts A and B, often with additional benefits).

Part D: Prescription drug coverage (offered through private insurers to help cover the cost of medications).

What’s the difference between Original Medicare, Medicare Advantage, and Medicare Supplemental/Gap Plans?

Original Medicare (Parts A & B)

Offered by the federal government.

You can see any doctor or hospital that accepts Medicare.Covers hospital and medical services but does not include prescription drug coverage (you must add Part D separately).

You are responsible for deductibles, coinsurance, and copayments.

Medicare Advantage (Part C)
Offered by private insurers as an alternative to Original Medicare.
Includes Parts A and B, often Part D, and may offer additional benefits like vision, dental, and hearing.Plans may have network restrictions (e.g., HMO or PPO plans).

Medicare Supplemental/Medigap Plans
Offered by private insurers to work with Original Medicare.
Helps cover out-of-pocket costs like deductibles, coinsurance, and copayments.
Does not include additional benefits like vision, dental, or drug coverage (Part D is needed separately).
You must have Original Medicare to purchase a Medigap plan.

How much does Medicare cost?

Costs depend on your coverage:

Part A: Free for most people; otherwise, premiums can range upwards depending on your income.

Part B: Standard premium is $174.70/month in 2024 (may be higher based on income).

Part C (Medicare Advantage): Costs vary by plan and may include additional premiums.

Part D: Premiums vary by plan; higher-income individuals may pay a surcharge.

Additional costs include deductibles, copayments, and coinsurance..

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When can I enroll in Medicare?

Initial Enrollment Period (IEP): Starts 3 months before your 65th birthday, includes the month you turn 65, and ends 3 months after your birthday month.

Special Enrollment Period (SEP): Available if you delay enrollment due to having employer coverage.

General Enrollment Period (GEP): January 1 to March 31 each year, if you missed other periods, with coverage starting July 1 (may include penalties).

Annual Election Period (AEP): October 15 to December 7, allows changes to your Medicare Advantage or Part D plans for the following year.

Does Medicare cover all my healthcare costs?

No, Medicare does not cover all healthcare costs. You may still have to pay deductibles, copayments, and coinsurance. Original Medicare also does not cover services like:

Routine dental and vision care.

Hearing aids.

Long-term care (custodial care).

To help cover these gaps, many people purchase Medigap (Medicare Supplement Insurance) or choose a Medicare Advantage plan with additional benefits.

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