Can I get health insurance outside Open Enrollment?
Sometimes. Marketplace coverage generally requires enrolling during Open Enrollment unless you have a qualifying life event — such as losing other coverage, moving, marriage or a new child — which opens a Special Enrollment Period with a limited window. Some products sold outside the Marketplace have different enrollment timing, but they may also apply underwriting or cover less. Confirm the rules that apply to your situation before assuming either way.
Can I keep my doctor?
It depends on whether that doctor participates in the specific plan's network, not just with the insurance company. Networks differ plan to plan and change over time. The reliable approach is to verify with both the carrier and the provider's office for the exact plan you are considering.
Should I choose a PPO or an HMO?
Neither is better in general. A PPO usually offers more network flexibility and specialist access without referrals, at a higher premium. An HMO usually costs less and coordinates care within a narrower network. The right answer depends on which doctors you want to keep and how much flexibility you would actually use.
What deductible should I choose?
That depends on how often you expect to use care and how much you could comfortably absorb in a difficult year. A higher deductible lowers the premium and raises what you pay when you use care. Look at the out-of-pocket maximum alongside the deductible — it describes your ceiling.
What is an out-of-pocket maximum?
It is the most you would pay for covered services in a plan year. After you reach it, the plan generally pays 100% of covered in-network services for the rest of the year. Premiums do not count toward it, and neither do services the plan does not cover.
How does coinsurance work?
Coinsurance is a percentage of the cost of a covered service that you pay after meeting your deductible. If a plan lists 20% coinsurance, you pay 20% of the negotiated cost and the plan pays the rest, until you reach your out-of-pocket maximum.
What happens if I lose employer coverage?
Losing employer coverage is generally a qualifying life event that opens a Special Enrollment Period for individual coverage. Continuation coverage such as COBRA may also be available, typically at full unsubsidized cost. The windows are short, so start before your coverage ends if possible.
What if I'm self-employed?
You would generally shop individual or family coverage directly, through the Marketplace where income-based financial help may be available, or privately. Because you pay the full premium yourself, the balance between monthly cost and potential exposure in a high-use year deserves more attention than usual.
How does group health insurance work for a small business?
The business sponsors a plan, decides how much of the premium it contributes, and offers it to eligible employees. Carriers commonly apply participation and contribution requirements, and terms are reviewed at renewal each year. Specific rules vary by carrier and state.
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Ask Dave PersonallyPlan availability, eligibility, benefits, exclusions, underwriting requirements, enrollment periods and coverage vary by carrier, product and state.