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Individual and Family - Washington

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Small Group FAQs

General InformationWhat is individual health insurance?Individual health insurance is a type of health insurance policy that is purchased by an individual, rather than a group or employer.
General InformationWho can purchase individual health insurance?Anyone who is not eligible for employer-sponsored health insurance or government programs like Medicare or Medicaid can purchase individual health insurance as long as it is open enrollment or they have a qualifying event.
General InformationWhat does individual health insurance cover?Individual health insurance policies typically cover a range of medical expenses, including hospitalization, doctor visits, prescription drugs, and preventative care.
General InformationHow do I purchase individual health insurance?You can purchase individual health insurance through a licensed insurance agency (such as Owen Rose Benefits), directly from an insurance company, or through a health insurance marketplace like Healthcare.gov.

Using the services of an Insurance Agency allows you to receive guidance from trained professionals that can help explain complex insurance concepts to help you make an informed decision.
General InformationWhen can I purchase individual health insurance?The open enrollment period for individual health insurance typically runs from November 1 to December 15 each year. You may also be able to enroll outside of open enrollment if you experience a qualifying life event, such as losing your job or getting married.
Coverage OptionsWhat are the different types of individual health insurance plans?There are several types of individual health insurance plans, including HMOs, PPOs, EPOs, and POS plans. Each plan has different benefits, costs, and network restrictions.
Coverage OptionsWhat is a high-deductible health plan (HDHP)?A high-deductible health plan is a type of health insurance plan with a high deductible, which is the amount you have to pay out of pocket before your insurance coverage kicks in. HDHPs are often paired with health savings accounts (HSAs), which allow you to save pre-tax money to pay for medical expenses.
Coverage OptionsCan I get coverage for pre-existing conditions with individual health insurance?Yes, under the Affordable Care Act (ACA), individual health insurance plans cannot deny coverage or charge higher premiums based on pre-existing conditions.
Costs and PaymentsHow much does individual health insurance cost?The cost of individual health insurance varies based on factors like your age, location, and health status, as well as the type of plan you choose. You may be eligible for premium subsidies or cost-sharing reductions if you purchase a plan through a health insurance marketplace and meet certain income requirements.
Costs and PaymentsWhat is a premium subsidy?A premium subsidy is a type of financial assistance that helps lower the cost of monthly premiums for individuals and families who purchase health insurance through a health insurance marketplace. The amount of the subsidy is based on your income and household size.
Costs and PaymentsWhat are out-of-pocket costs?Out-of-pocket costs refer to the expenses you pay for medical care that are not covered by your insurance, such as deductibles, copayments, and coinsurance. These costs can vary depending on your plan and the type of medical services you receive.
Enrollment and RenewalWhen can I enroll in an individual health insurance plan?You can typically enroll in an individual health insurance plan during the open enrollment period, which is usually from November 1st to December 15th each year. Some states have extended open enrollment periods or allow for special enrollment periods outside of the standard enrollment window if you experience a qualifying life event, such as losing your job or getting married.
Claims and BenefitsWhat types of services are typically covered under an individual health insurance plan?Individual health insurance plans typically cover a range of essential health benefits, including preventive care, doctor visits, hospital stays, prescription drugs, and mental health services. The specific benefits and coverage levels can vary depending on the plan you choose and your state's regulations.
Coverage OptionsWhat is a provider network?A provider network is a group of healthcare providers, such as doctors, hospitals, and clinics, that have contracted with a health insurance company to offer services to plan members at discounted rates. Depending on your plan, you may be required to stay within the network to receive full coverage for services. If you go out of network, you may be responsible for higher costs.
Claims and BenefitsWhat are deductibles and co-pays?Deductibles and co-pays are both types of out-of-pocket costs for healthcare. A deductible is the amount you have to pay out of pocket before your insurance kicks in. A co-pay is a fixed amount you pay for a healthcare service, typically at the time of service.
Costs and PaymentsWhat are health insurance premiums?Health insurance premiums are the amount you pay for your health insurance policy. These are typically paid monthly.
Additional Plans and ProgramsWhat are critical illness and hospital indemnity plans?Critical illness and hospital indemnity plans are supplemental insurance policies that pay out a lump sum of cash if you are diagnosed with a critical illness or admitted to the hospital. These plans are designed to help cover expenses that your health insurance may not fully cover.
Additional Plans and ProgramsWhat are medishare plans?Medishare plans are faith-based healthcare sharing programs in which members pool their resources to cover each other's medical bills. Members pay a monthly premium and contribute to a fund that is used to pay for healthcare expenses of other members.
Additional Plans and ProgramsWhat is Direct Primary Care (DPC)?Direct Primary Care is a healthcare model in which patients pay a monthly fee directly to their primary care provider for basic healthcare services. In return, patients typically receive more personalized care and have greater access to their provider.
Additional Plans and ProgramsWhat is Medicaid?Medicaid is a government-run healthcare program that provides health insurance to low-income individuals and families. Eligibility for Medicaid varies by state and is based on income and other factors. Medicaid typically covers a wide range of healthcare services, including doctor visits, hospitalization, and prescription drugs.