Frequently Asked Questions

Get clear answers about private health insurance, Marketplace coverage, PPO plans, self-employed coverage, costs, eligibility, and working with AE Health Solutions.

✦ What's the difference between Obamacare, Employer Plans, and Private Insurance? -Marketplace (or Obamacare) plans are generally available regardless of pre-existing conditions and may include income-based subsidies for eligible applicants. -Employer-sponsored plans are often cost-effective for employees, but dependent coverage can sometimes be expensive. -Private health insurance is typically medically underwritten, meaning eligibility and rates may depend on your health history and other factors. For qualifying applicants, private plans may offer competitive rates, broader PPO options, and lower out-of-pocket costs depending on the plan.

✦ Is open enrollment the only time I can shop for health insurance? Marketplace plans generally require Open Enrollment or a qualifying life event to enroll outside that period. Private health insurance may be available year-round, depending on eligibility.

✦ Is private insurance affordable? It absolutely can be! Rates for private coverage depend on factors such as age, health, location, and plan design. For some healthy individuals and families, private plans may offer competitive pricing and benefits compared with other options.

✦ Are there contractual obligations? No! Many private health plans can be canceled without a long-term contract, but terms vary by plan. We’ll review those details with you before enrollment.

✦ How do I know if I have nationwide coverage? If you have a PPO plan, you’re in a good spot! PPO plans often provide access to broader provider networks and may offer coverage across multiple states. HMO, EPO, and POS plans can have more restricted networks, so it’s important to review the specific plan’s provider network and out-of-area benefits.

✦ What fees do you charge? My clients never pay me a single penny and they have me for the lifetime of their policy! There is no fee for your consultation or ongoing support. I’m here to help you understand your options, enroll in coverage, and answer questions throughout the life of your policy. Think of me as your own personal health insurance guru!

✦ Do you offer other types of insurance plans? Absolutely, glad you asked! Outside of health insurance, I am licensed to offer my clients dental, vision, and life insurance. I can customize plans to your needs whether you’re just looking for supplemental coverage or even critical illness and income protection (short term disability).

✦ Can self-employed people get private health insurance? Yes. Self-employed individuals, freelancers, independent contractors, and 1099 workers can purchase health insurance on their own rather than through an employer. Private health plans may be an option for applicants who qualify based on the plan’s eligibility requirements. AE Health Solutions helps self-employed individuals compare available coverage and understand which options may fit their health needs, lifestyle, and budget.

✦ Do private health plans cover families? Yes. Private health insurance may be available for individuals, couples, and families. Depending on the plan, you may be able to cover a spouse and dependent children under the same policy. AE Health Solutions can help families compare private coverage with other available options and determine which approach makes the most sense for their needs and budget.

✦ What is medically underwritten health insurance? Medically underwritten health insurance is coverage where the insurance company may review an applicant’s health history when determining eligibility, rates, or available benefits. Because these plans are not guaranteed issue, they may not be appropriate for everyone. A licensed health advisor can help explain the underwriting process and determine whether private coverage is worth considering.

✦ Can I keep my doctor with a private health plan? Possibly. Whether you can keep your doctor depends on the provider network associated with the specific health plan. Before enrolling, it is important to verify that your preferred doctors, specialists, hospitals, and other providers participate in the plan’s network. AE Health Solutions can help review provider access before you make a decision.

✦ What is the difference between a PPO and an HMO? A PPO generally gives members more flexibility to see providers within a broader network and may allow some out-of-network care. An HMO typically requires members to use a more defined provider network and may require referrals for certain specialists. The right network type depends on how you use healthcare, where you live, which doctors you want to see, and how much flexibility you want.

✦ Who is private health insurance best for? Private health insurance may be worth exploring for healthy individuals, families, self-employed professionals, 1099 workers, small business owners, and people who purchase coverage outside an employer. Whether private coverage is a good fit depends on your health, budget, location, provider preferences, and insurance needs. AE Health Solutions can help compare your available options.

✦ Is private health insurance the same as Marketplace insurance? No. Private health insurance and Marketplace insurance are different types of coverage. Marketplace plans are offered through the federal or state health insurance Marketplace and may include income-based subsidies. Private health plans are purchased outside the Marketplace and may have different eligibility requirements, provider networks, benefits, and pricing.

✦ Do private health plans cover pre-existing conditions? Coverage for pre-existing conditions varies by plan. Marketplace-compliant plans cannot deny coverage because of pre-existing conditions. Some private medically underwritten plans may have eligibility requirements or limitations related to an applicant’s health history. It is important to review the specific plan carefully before enrolling.

✦ How much does private health insurance cost? The cost of private health insurance varies based on factors such as age, location, household size, health history, plan design, and available benefits. There is no single price that fits everyone. AE Health Solutions can compare available options and help you understand the tradeoffs between monthly premiums, deductibles, networks, and out-of-pocket costs.

✦ Is private health insurance cheaper than Marketplace insurance? Sometimes, but not always. Private plans may be competitively priced for certain applicants, while Marketplace plans may be more affordable for people who qualify for substantial premium subsidies. The better value depends on your individual situation, so it is important to compare both cost and benefits rather than looking only at the monthly premium.

✦ Can I get health insurance if I recently lost my job? Yes. Losing employer-sponsored health coverage can create several possible options, including COBRA, Marketplace coverage through a Special Enrollment Period, or private health insurance if you qualify. A health advisor can help you compare those options and understand the differences in cost, networks, and benefits.

✦ What health insurance options do 1099 workers have? 1099 workers may have several options, including Marketplace coverage, private health insurance, coverage through a spouse, or certain association or group arrangements when available. Because independent contractors do not receive employer-sponsored health insurance in the traditional way, comparing options carefully is especially important.

✦Can small business owners buy private health insurance? Yes. Small business owners may purchase individual or family health insurance outside of their business, and some businesses may also qualify for group health coverage. The right approach depends on the number of employees, business structure, budget, and coverage goals. AE Health Solutions can help business owners understand the available paths.

✦Do I need a health insurance broker or advisor? You are not required to use one, but a licensed health insurance advisor can make the process much easier. An advisor can help explain plan differences, compare networks and benefits, answer questions, and help you avoid choosing coverage based only on price. AE Health Solutions provides consultations at no cost to the client.

✦Does AE Health Solutions charge a fee for its services? No! There is no fee to speak with me, compare your options, or get help enrolling in a health insurance plan. AE Health Solutions is typically compensated by the insurance carrier when a client enrolls in an eligible plan, so clients do not pay a separate consultation or advisory fee for our help. My role is to help you understand your options, compare coverage, and choose a plan that fits your needs and budget.

✦Can a health insurance advisor help me compare plans? Yes. A licensed health insurance advisor can help compare premiums, deductibles, provider networks, prescription benefits, out-of-pocket costs, and other plan features. This can be especially helpful when two plans look similar at first but differ significantly in how they work when you actually need care.

✦What should I look for when choosing health insurance? Look beyond the monthly premium. Important factors include the deductible, copays, coinsurance, maximum out-of-pocket cost, provider network, prescription coverage, specialist access, hospital coverage, and whether your current doctors participate in the plan.

✦What is a health insurance deductible? A deductible is the amount you may need to pay for certain covered healthcare services before the insurance plan begins paying according to its terms. Different services may be treated differently, so a low monthly premium does not necessarily mean a plan will cost less overall.

✦What is a maximum out-of-pocket cost? The maximum out-of-pocket amount is the most you are generally required to pay for covered in-network services during a plan year before the plan begins covering eligible services according to its terms. Premium payments and certain non-covered expenses typically do not count toward this amount.

✦What is coinsurance? Coinsurance is the percentage of a covered medical expense that you are responsible for after meeting applicable plan requirements. For example, a plan might pay a portion of an eligible bill while the member is responsible for the remaining percentage.

✦What is a copay? A copay is a fixed amount you may pay for certain healthcare services, such as a doctor visit, urgent care visit, or prescription. Copays vary by plan and service.

✦How do I know if a health plan includes my prescriptions? Prescription coverage varies by plan, so you should check the plan’s drug formulary before enrolling. A formulary is the list of medications covered by the insurance plan. It is important to check both whether your medication is covered and what tier or cost-sharing level applies.

✦Can I use private health insurance when traveling? That depends on the plan and provider network. Some PPO-style plans may provide broader access to providers across multiple states, while other plans have more limited service areas. Emergency care may also be treated differently from routine care, so travelers should review the plan’s network and out-of-area benefits carefully.

✦Can I change health insurance plans during the year? It depends on the type of coverage. Marketplace plans generally have enrollment restrictions outside Open Enrollment unless you experience a qualifying life event. Private health plans may have different enrollment and cancellation rules. Always review the specific policy terms before making a change.

✦What happens during a free consultation with AE Health Solutions? During a consultation, April will learn about your current coverage, healthcare needs, budget, provider preferences, and what you are looking for in a plan. She can then explain available options, answer questions, and help you determine which type of coverage may be worth considering. There is no obligation to enroll.

✦What information should I have ready for a health insurance consultation? It helps to know your age, ZIP code, household size, current coverage, preferred doctors or hospitals, medications, approximate budget, and when you need coverage to begin. For private medically underwritten coverage, additional health information may be needed during the application process.

✦How quickly can health insurance coverage begin? Start dates vary by plan. Some private health plans may offer relatively quick effective dates after approval, while Marketplace and employer plans follow their own enrollment schedules. Your advisor can tell you the available effective dates before you apply.

✦Can AE Health Solutions help with dental and vision insurance too? Yes. AE Health Solutions can also help clients explore dental and vision coverage in addition to health insurance. These plans can sometimes be purchased separately or alongside other coverage depending on the carrier and product.

✦Does AE Health Solutions offer life insurance? Yes. AE Health Solutions can also help clients explore life insurance options in addition to health, dental, and vision coverage. The appropriate type and amount of life insurance depends on your family, income, financial obligations, and long-term goals.

Common Situations We Help With

✦I’m self-employed and pay for my own insurance. Can you help? Yes. Self-employed and 1099 clients are one of the groups AE Health Solutions frequently assists. April can help compare private and other individual health insurance options based on your needs and eligibility.

✦My employer’s family plan is too expensive. Do I have other options? Possibly. In some cases, spouses or dependents may have other individual or private coverage options. The best choice depends on your household, employer contribution, eligibility, and available plans.

✦I don’t qualify for a Marketplace subsidy. Should I look at private insurance? It may be worth comparing. People who do not qualify for significant Marketplace subsidies may find that private plans offer another option, depending on health eligibility and coverage needs.

✦I’m between jobs. Can AE Health help me find temporary coverage? Yes. Depending on your situation, possible options may include COBRA, Marketplace coverage, or private health insurance. April can help compare the available choices rather than assuming one option is automatically best.

Looking for more than Health Insurance?

Dental

Choose from top-tier PPO dental plans that include 100% coverage for preventive care—effective immediately. These plans cover two cleanings per year, spaced six months apart. Many options also provide coverage for basic and major care needs through major networks such as Careington Dental PPO, DenteMax PPO, and National Options PPO 30!

Vision

Select a vision plan that offers comprehensive eye exams every year, fully covered from day one. These plans include essential services such as eye exams, dilation, and more. Additionally, they offer annual credits of $100–$150+ toward glasses or contacts with major networks like Spectera Eyecare Network and EyeMed.

Life

Consider a 10-year term life insurance plan that provides peace of mind for your family by offering valuable benefits in the event of an unforeseen circumstance.