Frequently Asked Questions | Lavon Sider Insurance Agency, Inc.

Question 1

What is health insurance and why do I need it?

Accepted Answer

Health insurance helps cover the cost of medical care — from routine checkups to unexpected emergencies. Without it, a single hospital visit can result in thousands of dollars in bills. A good plan protects your health and your finances.

Question 2

What is the Health Insurance Marketplace® and why should I use an agent?

Accepted Answer

The Health Insurance Marketplace® offers health insurance plans for individuals and families and may provide financial assistance that can significantly reduce monthly premium costs for those who qualify. Working with an agent gives you personalized guidance to help you compare plans, understand your benefits, determine your eligibility for savings, and enroll with confidence—all at no additional cost to you.

Question 3

How does the Affordable Care Act affect my premiums?

Accepted Answer

The Affordable Care Act (ACA) provides consumers with subsidies ("premium tax credits") that lower costs for households with incomes between 100% and 400% of the federal poverty level (FPL). Depending on your household income, you may qualify for financial assistance that can lower your monthly health insurance premium. If you receive more assistance than you’re eligible for—or less than you’re eligible for—the difference may be reconciled when you file your federal tax return.

Question 4

What's the difference between a premium, deductible, and copay?

Accepted Answer

Your premium is the monthly amount you pay to maintain your health insurance coverage. Your deductible is the amount you pay out-of-pocket for covered services before your insurance starts sharing costs. A copay is a fixed amount you pay for a specific service (like a $30 doctor visit), usually after your deductible is met.

Question 5

What does "in-network" vs. "out-of-network" mean?

Accepted Answer

Insurance companies negotiate discounted rates with certain doctors and hospitals — those are "in-network." Seeing an out-of-network provider usually costs more, and some plans won't cover out-of-network care at all. We'll help you find a plan whose network includes the providers you already use.

Question 6

When can I enroll in a health plan?

Accepted Answer

For Health Insurance Marketplace® plans, the main window is Open Enrollment — typically November 1 through January 15. If you have a qualifying life event (losing job-based coverage, getting married, or having a baby, etc.) you are likely eligible for a Special Enrollment Period.

Question 7

What counts as a qualifying life event?

Accepted Answer

Common qualifying events include: losing health coverage (job loss, aging off a parent's plan), getting married or divorced, having or adopting a child, moving to a new coverage area, and changes in income that affect your eligibility for subsidies. You typically have 60 days from the event to enroll.

Question 8

Can I get coverage if I missed open enrollment?

Accepted Answer

Possibly. Short-term health plans are available year-round and don't require a qualifying event. They're not a permanent solution, but they can bridge the gap until you're eligible to enroll in a comprehensive plan.

Question 9

How long does it take for coverage to start?

Accepted Answer

It depends on when you enroll. Plans purchased during open enrollment typically start January 1. If you enroll mid-month due to a qualifying event, coverage usually begins the first of the following month. Short-term plans can sometimes start as quickly as the next day.

Question 10

How much does health insurance cost?

Accepted Answer

Costs vary widely based on your age, location, plan type, and household income. Premiums can range from under $100/month to several hundred dollars. Many people qualify for federal subsidies through the Health Insurance Marketplace® that significantly reduce their monthly premium — sometimes to $0.

Question 11

Do I qualify for a subsidy or tax credit?

Accepted Answer

You may qualify for a premium tax credit or a reduction in your monthly premium if your household income falls between 100% and 400% of the federal poverty level (and in some cases higher). We'll help you estimate your eligibility and find plans that maximize your savings.

Question 12

Is there a fee for not having health insurance?

Accepted Answer

There's no longer a federal penalty for being uninsured, but going without coverage is a significant financial risk. One unexpected illness or injury can result in bills that far exceed what you'd have paid in premiums. We can usually find affordable options that make coverage worth it.

Question 13

Do you charge a fee for your help?

Accepted Answer

No — our guidance is completely free to you. As a licensed independent agent, we're compensated by the insurance carriers when you enroll through us. You get unbiased, personalized advice at no extra cost.

Question 14

When should I sign up for Medicare?

Accepted Answer

You're first eligible for Medicare at age 65. Your Initial Enrollment Period starts 3 months before your 65th birthday and ends 3 months after. Missing this window without other qualifying coverage can result in permanent late enrollment penalties.

Question 15

What does Original Medicare cover?

Accepted Answer

Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). Part A covers inpatient hospital stays, skilled nursing, and some home health care. Part B covers doctor visits, outpatient services, and preventive care. Neither covers everything — which is where Medicare Supplement plans come in.

Question 16

What's the difference between Medicare Supplement and Medicare Advantage?

Accepted Answer

A Medicare Supplement (Medigap) plan works alongside Original Medicare to cover things like copays and coinsurance. Medicare Advantage (Part C) integrates Medicare Part A and Part B coverage with additional medical benefits not covered by Original Medicare.  Each has pros and cons — we'll walk you through both.

Question 17

Can I change my Medicare Advantage or Medicare Supplement plan after I enroll?

Accepted Answer

Yes, with some restrictions. Medicare Advantage and Part D drug plans can be changed during the Annual Enrollment Period (October 15 – December 7). Switching Medicare Supplement plans may require medical underwriting outside of your initial enrollment window.

Straight Answers to Common Questions

Your Question Isn't on the List?