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Health FAQs

Health FAQs

  1. An Individual Health Plan is available for individuals and families not utilizing a group health insurance plan though an employer. Your American Family agent can provide more detailed info.
  2. The ACA is the Affordable Care Act known to many as Obamacare. This is the new government-established healthcare law
  3. Health insurance ensures you can get the care you need should a medical issue arise. And under the new law, everybody is required to be insured. Failure to do so will result in a government penalty. Nobody wants that!
  4. You can only sign up for health insurance during the open enrollment period or under special circumstances, such as losing your coverage because of a job layoff, etc. If you become ill and don’t have insurance, you’ll be responsible for 100% of your health care costs. And those can add up fast!
  5. Many factors are considered when determining your premium, including:

    • Tobacco/non-tobacco use
    • Selection of deductible, coinsurance and benefit options
    • The age of you and your spouse (if applicable) on the policy effective date
    • Coverage options, for example: single, applicant/spouse, applicant and child(ren) or full family
    • Location of residence
  6. Yes. Individual plans can be purchased as a single plan or a family plan.
  7. A copayment (or copay) is a fixed dollar amount or percentage of cost that must be paid each time services are received. You should be prepared to pay your copayment to the provider at the time of your visit.
  8. Co-insurance is generally a fixed percent of a covered healthcare cost for which you have financial responsibility, typically after the deductible has been fulfilled.
  9. A deductible is a specified dollar amount that the member or family is required to pay out-of-pocket each contract year before your health plan will pay for specific services. Depending on your policy, some services may or may not require you to pay your deductible.
  10. Open enrollment is the period of time during which individuals may enroll in a Qualified Health Plan. Open Enrollment periods may vary by year but typically remain open for only a few months.
  11. Special enrollment is the period of time between open enrollment periods where qualifying individuals may enroll in a health plan for 60 days after a qualifying life event. Examples of a life event include moving to a new zip code, losing health insurance coverage, and changes to your family size (such as marriage or the birth of a child).
  12. For most people, the last day to enroll in a health is at the end of Open Enrollment for that particular year. But in some cases, you still may be able to get coverage that same year after Open Enrollment has closed.

    There are three ways to get coverage outside of Open Enrollment:

    1. If you experience a life change — like getting married, having a baby, or losing health coverage — that qualifies you for a Special Enrollment Period, you may be able to enroll in a Marketplace plan outside Open Enrollment.
    2. If you qualify, through Medicaid or the Children’s Health Insurance Program (CHIP).
    3. You can purchase a short term medical policy, however you may be declined due to medical conditions and may still receive a penalty for not purchasing an individual medical policy.

Group Plans

  1. A group health plan is an insurance plan a company offers its employees and possibly their family members.
  2. Many factors determine your group insurance premium, including:

    • Plan selection
    • Location of the company
    • Demographics of your employees (age, gender, single/family, location of employee’s residence)
    • Larger groups may be affected by health of employees and claims experience
  3. Some employers who decide to offer coverage choose to pay the full premium, while others require employees to pay a portion. When considering what portion of the premium to pay, employers should be aware that the Affordable Care Act offers small businesses tax credits to help offset the cost of insurance.
  4. We work with multiple carriers who will have access to a wide variety of provider options. Talk with your American Family agent about which option may be best for your company and employees.

Medicare Supplement Plans

  1. Medicare is a federal health program for:

    • People age 65 or older.
    • People under age 65 with certain disabilities.
    • People of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant).
  2. You qualify at age 65 or older if:

    • You are a U.S. citizen or a permanent legal resident; and
    • You or your spouse has worked long enough to be eligible for Social Security or railroad retirement benefits — usually having earned 40 credits from about 10 years of work — even if you are not yet receiving these benefits
    • If you aren't yet 65, you might also qualify for coverage if you have a disability or with end-stage renal disease (permanent kidney failure requiring dialysis or transplant).
  3. A Medicare supplement health plan helps cover what Medicare doesn’t. Medicare covers a lot of health care expenses, but as you know it doesn’t pay for everything. There are deductibles and coinsurance you may have to pay in addition to the portion Medicare pays. And there’s always a chance that a serious illness or injury could exhaust some of your Medicare benefits. That’s where a Medicare Supplement plan comes into play.
  4. If your doctor accepts Medicare, they’ll accept the Medicare Supplement.

Short-Term Health Plans

  1. When a life change leaves you without health insurance, you need coverage to get you through the transition period. With a short-term health insurance plan you can select the length of time (1 to 11 months in many states) and choose from a range of available deductible amounts and payment options. And when your needs change, you have the flexibility to drop your coverage at any time without a penalty.

    A Short Term Health insurance plan may be right for you if you are:

    • Between jobs or unemployed
    • A young adult no longer covered under a parent's insurance plan
    • An early retiree
    • Waiting for other coverage to begin

    Temporary insurance plans are usually more affordable than traditional individual health coverage. However, you may incur a tax penalty depending on the length of time you have a short term policy.

Supplemental Coverage Options

  1. Supplemental plans are designed to work with your existing health insurance. They provide added protection in a sometimes unpredictable world. American Family offers critical illness, accident, and dental coverage.
  2. The supplemental products are separate plans from the health insurance plan and will provide benefits independently from your health coverage.