Question 1

What is the difference between an HMO and a PPO plan?

Accepted Answer

An HMO (Health Maintenance Organization) requires you to choose a primary care physician and get referrals to see specialists. Care is limited to in-network providers, which keeps premiums lower. A PPO (Preferred Provider Organization) gives you more flexibility — you can see any doctor without a referral, including out-of-network providers, though at a higher cost. PPOs generally have higher premiums but are a good fit if you want freedom of choice.

Question 2

When can I enroll in an individual health insurance plan?

Accepted Answer

In California, the Open Enrollment Period runs October 15 through January 31. In Nevada, it runs November 1 through January 15. Outside of open enrollment, you may qualify for a Special Enrollment Period if you experience a qualifying life event such as losing job-based coverage, getting married, having a baby, or moving to a new coverage area.

Question 3

Do I qualify for financial assistance with my premiums?

Accepted Answer

You may qualify for premium tax credits through Covered California or Nevada Health Link if your household income falls between 100% and 400% of the federal poverty level — and in some cases even higher due to enhanced subsidies. The amount of assistance depends on your income, household size, and the plan you choose. Our advisors can run a free eligibility check and help you maximize your savings.

Question 4

What does a deductible mean, and how does it affect my costs?

Accepted Answer

Your deductible is the amount you pay out of pocket for covered services before your insurance begins to share costs. For example, if your deductible is $1,500, you pay the first $1,500 of covered medical expenses each year. After that, your plan typically covers a percentage of costs (coinsurance) until you reach your out-of-pocket maximum, at which point the plan covers 100% of covered services.

Question 5

Are pre-existing conditions covered under ACA plans?

Accepted Answer

Yes. All ACA-compliant individual and family health plans are required by law to cover pre-existing conditions. Insurers cannot deny coverage or charge you more based on your health history. This protection applies to plans sold through Covered California, Nevada Health Link, and directly through insurers.

Question 6

What are the different parts of Medicare?

Accepted Answer

Medicare has four main parts. Part A covers hospital stays, skilled nursing facility care, and some home health services — most people pay no premium for Part A. Part B covers outpatient care, doctor visits, and preventive services, with a monthly premium. Part C (Medicare Advantage) is an alternative to Original Medicare offered by private insurers, often bundling Parts A, B, and D with extra benefits. Part D covers prescription drugs and is available as a standalone plan or included in a Medicare Advantage plan.

Question 7

When should I enroll in Medicare?

Accepted Answer

Your Initial Enrollment Period begins three months before the month you turn 65 and ends three months after. If you miss this window without qualifying coverage elsewhere, you may face a late enrollment penalty that increases your premium permanently. If you're still working and covered by an employer plan, you may be able to delay Part B without penalty. We strongly recommend reviewing your situation with an advisor before your 65th birthday.

Question 8

What is a Medicare Supplement (Medigap) plan?

Accepted Answer

A Medicare Supplement plan, also called Medigap, is private insurance that helps pay costs not covered by Original Medicare — such as copayments, coinsurance, and deductibles. Medigap plans are standardized by the federal government, meaning Plan G from one insurer offers the same benefits as Plan G from another. The main difference between insurers is the premium. Medigap plans do not include prescription drug coverage, so you would also need a Part D plan.

Question 9

What is the Annual Enrollment Period for Medicare?

Accepted Answer

The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year. During this time, you can switch from Original Medicare to a Medicare Advantage plan, switch between Medicare Advantage plans, or change your Part D drug plan. Changes made during AEP take effect January 1 of the following year. This is the best time to review your coverage and make sure your plan still meets your needs.

Question 10

Does Medicare cover dental, vision, and hearing?

Accepted Answer

Original Medicare (Parts A and B) does not cover routine dental care, eyeglasses, or hearing aids. However, many Medicare Advantage (Part C) plans include these benefits as extras. If you have Original Medicare, you can purchase a standalone dental and vision plan to fill this gap. Our advisors can help you find a plan that covers the services most important to you.

Question 11

How many employees do I need to offer group health insurance?

Accepted Answer

In California and Nevada, businesses with as few as one full-time equivalent employee (other than the owner) may be eligible for small group health insurance. Most carriers require that a minimum percentage of eligible employees — typically 70% — enroll in the plan. Our advisors can help you determine eligibility and find a plan that fits your workforce.

Question 12

Are employer contributions to group health premiums tax-deductible?

Accepted Answer

Yes. Employer contributions to employee health insurance premiums are generally fully tax-deductible as a business expense. Additionally, if you set up a Section 125 cafeteria plan, employees can pay their share of premiums with pre-tax dollars, reducing payroll taxes for both the employer and the employee. We recommend consulting with your tax advisor for guidance specific to your business.

Question 13

Can employees add their family members to a group health plan?

Accepted Answer

Yes. Most group health plans allow employees to add spouses, domestic partners, and dependent children up to age 26. The employer typically covers a portion of the employee's premium, while the employee pays the full cost of dependent coverage — though some employers choose to contribute toward dependent premiums as well.

Question 14

What is the difference between a group HMO and a group PPO?

Accepted Answer

A group HMO requires employees to select a primary care physician and get referrals for specialist visits. Care is limited to in-network providers, which keeps premiums lower — making it a popular choice for cost-conscious employers. A group PPO offers more flexibility, allowing employees to see any provider without a referral. PPOs typically have higher premiums but are valued by employees who want broader access to care.

Question 15

Do I need dental insurance if I already have health insurance?

Accepted Answer

Most individual and family health insurance plans do not include dental coverage for adults. Dental insurance is typically purchased as a separate standalone policy. Given that routine cleanings, X-rays, and unexpected procedures can add up quickly, a dental plan is a cost-effective way to protect your oral health and budget.

Question 16

What does a typical dental plan cover?

Accepted Answer

Most dental plans are structured around three tiers of care. Preventive services — such as cleanings, exams, and X-rays — are typically covered at 100% with no waiting period. Basic restorative services like fillings are usually covered at 70–80% after a short waiting period. Major services such as crowns, bridges, and dentures are typically covered at 50% and may have a longer waiting period. Orthodontics may be available as an add-on.

Question 17

What does vision insurance typically cover?

Accepted Answer

Most vision plans cover one comprehensive eye exam per year, along with an annual allowance toward eyeglass frames, lenses, or contact lenses. Some plans also offer discounts on LASIK surgery. The allowance amount varies by plan — typically ranging from $100 to $200 for frames or contacts. Our advisors can help you find a plan that matches your prescription needs and budget.

Question 18

Can I get dental and vision coverage together?

Accepted Answer

Yes. Many insurers offer bundled dental and vision plans at a lower combined premium than purchasing each separately. These bundles are a convenient and affordable option for individuals and families who want comprehensive coverage for both types of care.

Question 19

What is the difference between term and whole life insurance?

Accepted Answer

Term life insurance provides coverage for a specific period — typically 10, 20, or 30 years — and pays a death benefit if you pass away during that term. It is the most affordable type of life insurance and is ideal for covering temporary needs like a mortgage or income replacement during working years. Whole life insurance provides permanent coverage for your entire life and builds cash value over time that you can borrow against. It is more expensive but offers lifelong protection and a savings component.

Question 20

How much life insurance coverage do I need?

Accepted Answer

A common rule of thumb is to have coverage equal to 10–12 times your annual income, though the right amount depends on your specific situation — including your debts, dependents, income replacement needs, and final expense costs. Our advisors use a needs-analysis approach to help you determine the right coverage amount without over- or under-insuring.

Question 21

What is final expense insurance?

Accepted Answer

Final expense insurance, also called burial insurance, is a small whole life policy designed to cover end-of-life costs such as funeral expenses, medical bills, and other debts. Coverage amounts typically range from $5,000 to $25,000. These policies are popular among seniors because they are easy to qualify for — many require no medical exam — and premiums are fixed for life.

Question 22

Is life insurance taxable?

Accepted Answer

In most cases, life insurance death benefits paid to your beneficiaries are income tax-free. The cash value growth inside a permanent life insurance policy also accumulates on a tax-deferred basis. However, there are some situations — such as large estates or certain policy structures — where tax implications may apply. We recommend consulting with a tax advisor for guidance specific to your situation.

Frequently Asked Questions

Individual Health Insurance

Medicare

Group Health Insurance

Dental & Vision

Life Insurance

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