Frequently Asked Questions

• What’s the difference between HMO, PPO and EPO plans?

HMO plans do not have out-of-network coverage unless the services are for emergency care. A referral from a primary care doctor is required for many services.

PPO – Members are allowed to see specialists and out-of-network doctors without a referral.

EPO – These plans use a PPO network with no out-of-network coverage.

• How do I know if my doctor is covered?

Insurance companies offer a provider search on their website.

• Is there coverage for pre-existing conditions?

The Affordable Care Act prohibits insurance companies from declining or limiting coverage due to a pre-existing condition.

• When can I apply for Medicare?

Generally, you can apply for Medicare 3 months before your 65th birthday. This initial enrollment window ends 3 months after you turn 65.

• Do individual plans have waiting periods for coverage to begin?

No.

• Do I need to file claims to get re-imbursed?

In-network providers will submit claims to the insurance company. You may have to submit claims if the provider is an out-of-network provider.

• How much will this cost?

If you provide me with your date of birth and you zip-code, I can provide a plan comparison.

• Do plans have lifetime limits?

No, insurance plans can no longer have limits essential health benefits.