Answers to the questions people ask most.

Coverage varies significantly by plan, but most major medical plans are designed to help with costs like doctor visits, hospital stays, emergency care, and prescriptions. Specific covered services depend on the plan you choose.

A premium is what you typically pay each month to keep a plan active. A deductible is generally the amount you pay out of pocket for covered services before the plan starts sharing costs. These amounts vary widely by plan.

Coinsurance usually refers to the percentage split of costs between you and your insurance plan after you've met your deductible. For example, the plan might cover a portion of a bill while you cover the rest, up to your out-of-pocket maximum.

This is generally the most you'd have to pay for covered services in a plan year before the plan typically covers 100% of additional covered costs. It resets each plan year and varies by plan.

Coverage for pre-existing conditions depends on the type of plan and applicable regulations. This is exactly the kind of detail we'll go over together before you commit to anything.

HMO plans generally require you to use a specific network of providers and often need referrals to see specialists, which can mean lower costs. PPO plans typically offer more flexibility to see out-of-network providers, often at a higher cost. Which fits better depends on your priorities.

2027 Open Enrollment begins November 1, 2026. For states using the federal Marketplace, Open Enrollment runs through December 15, 2026, a shorter window than in past years. Enrollment dates may vary in states that operate their own Marketplace. Employer and Medicare enrollment periods are set separately. We can help you figure out exactly when your window is.

In many cases, yes, if you qualify for a Special Enrollment Period due to a qualifying life event. Some plan types, like short-term medical, may also be available outside of standard enrollment windows depending on your state.

It's a window outside of standard Open Enrollment during which you may be able to enroll in or change coverage, typically triggered by a qualifying life event.

Common examples include losing other coverage, getting married or divorced, having a baby, or moving. Specific qualifying events depend on the type of plan and applicable rules.

Once you've chosen a plan, the application itself is often quick, sometimes same day, but processing and effective dates depend on the carrier and plan type.

Generally, plan changes outside of Open Enrollment require a qualifying life event, though this varies by plan type. We can help you understand your specific options.

Costs vary widely based on your age, location, household size, plan type, and coverage level. Rather than quote a general number that may not apply to you, we'll pull actual options based on your specific situation.

Premiums reflect factors like the plan's coverage level, deductible, network size, and the carrier's own pricing. Generally, lower premiums come with trade offs elsewhere, like a higher deductible.

Sometimes. Options can include choosing a higher deductible plan, checking eligibility for subsidies, or comparing carriers. We'll go over what applies to your situation.

Marketplace plans may come with income-based subsidies that reduce your premium, while private plans are priced directly by the carrier. Which is more cost effective depends on your income and household situation.

For marketplace plans, yes, subsidies are often tied to household income. For other plan types, income may not directly affect pricing, though it can affect eligibility for certain programs.

Depending on your income and household size, you may qualify for subsidies that reduce your monthly premium on marketplace plans. Eligibility is determined case by case.

In-network refers to doctors, hospitals, and providers that have agreed to specific rates with your insurance carrier. Using in-network providers generally means lower out-of-pocket costs.

Depending on your plan type, out-of-network care may cost significantly more, or in some HMO plans, may not be covered at all except in emergencies. We'll help you understand your plan's specific rules.

It depends on whether your doctor participates in a given plan's network. If keeping a specific provider matters to you, tell us up front. It's one of the first things we'll check.

Carriers typically maintain online provider directories, and we can also help confirm network participation directly before you enroll.

A narrow network plan generally includes a smaller, more limited group of providers, often in exchange for a lower premium. Whether that trade off makes sense depends on your priorities.

Most major medical plans include some prescription drug coverage, though specifics vary by plan and by medication.

A formulary is a list of medications a plan covers, usually organized into tiers that affect your cost for each drug.

You may have options like requesting an exception, switching to a covered alternative, or paying out of pocket. This is worth checking before enrolling if you take a specific medication regularly.

Generally, no. Generic medications typically cost less than brand name equivalents under most plan formularies, though this varies by plan.

This depends on the plan type. Major medical plans often begin on a set effective date after enrollment, while some supplemental plans may have a waiting period for certain benefits.

Some do, particularly for certain conditions or benefit types. We'll review the specific waiting period terms of any plan before you enroll.

Effective dates vary by plan type and enrollment timing. Sometimes it's the first of the following month, sometimes sooner. We'll confirm your specific effective date as part of enrollment.

In some cases, particularly if you're replacing existing continuous coverage, a waiting period may be reduced or waived. This depends on the carrier and plan.

Not usually for adults. Dental coverage is typically a separate, standalone plan or an add-on, though some plans for children may include it.

Many dental plans cover preventive care like cleanings and exams at little to no cost, with basic and major procedures typically covered at a percentage after a deductible. Coverage details vary by plan.

Many plans cover two cleanings per year as preventive care, though this varies by plan. We'll confirm the specifics for any plan you're considering.

Many vision plans offer an allowance you can put toward either glasses or contacts, but not usually both in the same benefit period. Specifics vary by plan.

Yes. Dental and vision are generally available as standalone plans, independent of whether you have a major medical plan.

In most cases, your provider files the claim directly with your insurance carrier on your behalf, especially for in-network care.

Usually not for in-network care. For out-of-network care or certain supplemental plans, you may occasionally need to submit a claim yourself. We can walk you through that process if it comes up.

You generally have the right to appeal a denied claim. The process and timeline vary by carrier, and we're glad to help you understand your options if this happens.

Processing times vary by carrier and claim complexity, but many straightforward claims are processed within a few weeks.

An EOB is a statement from your insurance carrier showing what was billed, what the plan covered, and what you may owe. It's not a bill itself, just a summary of how a claim was processed.