Frequently Asked Questions

YES. Even if you’re young and healthy, basic health insurance coverage is a must!
“Medical bills can be shocking,” warns Dr. Jordan Hollsten, a practicing surgeon in San Antonio, Texas. “Everything from medications to hospital fees to surgical center fees to medical equipment must be covered. And accidents and unexpected illness happen, which require care whether insurance is available or not.”

 The Affordable Care Act (ACA aka Obamacare) guarantees basic health insurance by ensuring plans provide minimum essential coverage (MEC), sometimes called “qualifying health coverage.” This is an insurance plan that meets the ACA requirement for health coverage. ACA plans are designed to help protect you and your family from the cost of routine and unexpected medical expenses. Under this law, all Obamacare plans include coverage for ten essential health benefits you’d expect – including emergency services, doctor visits, rehabilitation, maternity, and more.

A deductible is the amount of money you agree to pay for treatment before your health insurance policy begins to pay. Typically, a higher deductible means a lower monthly premium.
So, if your deductible is $1000, you’ll pay 100% of your healthcare expenses until you’ve hit $100. After you meet your deductible, you’ll be responsible for any cost-sharing (copayments or coinsurance) the plan requires.

Some insurance plans may include coinsurance, which means you’ll pay a percentage of the bill even after you’ve met your full deductible. It’s a way to share the cost of your healthcare service.
Let’s say you’ve met your deductible for the year. The next time you go to the doctor, instead of paying all costs, you and your plan will share the cost. So, if your coinsurance rate is 20% and the cost of a doctor’s visit is $100, you’ll pay $20, and your insurance will handle the remaining 80% of the bill.

A copayment is a set fee you pay for a healthcare service. You might have different copayments for doctors, hospital stays, prescription medication, and other types of care.
Your plan determines what your copay is for each service. It’s important to note that your copay can be independent of your deductible and coinsurance.

 It is essential to consider out-of-pocket expenses. Even if you have health insurance, you will likely pay for some of your care. Out-of-pocket costs represent your share of the medical expenses. Out-of-pocket costs represent what health insurance doesn’t cover. They include:

• Deductibles
• Coinsurance
• Copays
• Services that aren’t covered by your plan.

In addition to your premium, consider your out-of-pocket costs. Be aware of which services are covered, as well as which providers are in-network. Out-of-network care can increase your out-of-pocket costs substantially since these are services not generally covered by your plan. 

 Yes, there is a maximum out-of-pocket (MOOP) cost for most plans. Health insurance plans usually cap how much you spend on out-of-pocket expenses or out-of-pocket maximum. Under the Affordable Care Act (ACA), out-of-pocket maximums are established for plans sold on state marketplaces. For the 2023 plan year, the ceiling for out-of-pocket services is $9,100 for individuals and $18,400 for families. It’s important to note, however, that exceptions exist. So, even with an out-of-pocket limit, you could still be on the hook for additional expenses. Here are some of the things that don’t “count” toward your out-of-pocket maximum:

• Premiums
• Out-of-network care*
• Services not covered by your plan*
• Provider charges beyond the amount allowed for a service.

Review your plan to see limitations on services and coverage. If you go beyond those benefits, any expenses incurred may not factor into your out-of-pocket maximum.
*If you end up with out-of-network care, or if you want extra healthcare services not covered by your plan, you are held responsible for those costs entirely, no matter the maximum out-of-pocket. 

Absolutely! We would love to help you find the best coverage that fits you, your needs, and your budget!

We will review what you currently have, what you need, and what's out there and then evaluate if your current plan is the best affordable option for YOU! 

Turning 65 can be an exciting, yet confusing, time! Understanding the ins and outs of Medicare, Social Security and the options available can be daunting! Medicare choices are confusing and cost millions of dollars each year, don't let that happen to you! The first step is to schedule time with Crystal G Insurance Agency to go over YOUR individual health needs, medications, providers, and more!

Medicare is the federal health insurance program for people who are age 65 or older, people with End-Stage Renal Disease or permanent kidney failure requiring dialysis or a transplant, or individuals under 65 with disabilities.
It’s a fee-for-service healthcare program in which the government pays healthcare providers directly for services that fall under Parts A and B, also known as Original Medicare.

It has 4 parts: Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance), Medicare Part C (Medicare Advantage) and Medicare Part D (Prescription Drug Coverage). 

Medicare is divided into 4 categories, i.e. parts:

Medicare Part A (Hospital Insurance): This covers inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

Medicare Part B (Medical Insurance): This helps to cover services from doctors and other health care providers. It covers outpatient services, home health care, durable medical equipment (like wheelchairs, walkers, hospital beds), and other equipment. It also covers many preventive services like screenings, shots, vaccines, and yearly wellness visits. The standard Part B premium for 2024 is $174.80 per month.

Medicare Part C (Medicare Advantage): Medicare Advantage plans are Medicare-approved plans from a private company that offers an alternative to Original Medicare for your health and drug coverage. Medicare Advantage plans bundle Part A (Hospital), Part B(Medical), and usually Part D (Prescription Drugs). You MUST continue paying the standard Part B premium, although several plans offer Part B giveback options.

Medicare Part D (Prescription Drug Coverage):  This is Stand-alone prescription drug coverage that is offered by private companies approved by Medicare. 

Medicare supplement insurance plans, also known as Medigap, help pay for the costs that people with original Medicare incur, such as coinsurance, deductibles, and copayments.

Private insurance companies administer Medigap policies, which must follow Medicare rules. Some Medigap policies become unavailable when Medicare benefits change.