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.