Insurance Questions, Answered
Clear, simple answers to the 25 most common questions about Medicare, health insurance, life insurance, and supplemental coverage.
Medicare
Learn more about medicare →What is the difference between Medicare and Medicaid?
Medicare is federal health insurance for people 65+ or with certain disabilities, regardless of income. Medicaid is a joint federal-state program for people with limited income and resources. Some people qualify for both - called "dual eligibles" - and may receive additional cost-saving benefits. They are completely separate programs with different eligibility rules.
When should I sign up for Medicare?
Your Initial Enrollment Period starts 3 months before the month you turn 65 and ends 3 months after. If you're still working and covered by an employer plan with 20+ employees, you can delay Part B without penalty. Missing your enrollment window without qualifying coverage can result in a permanent late-enrollment penalty of 10% per year you were eligible but didn't enroll.
How much does Medicare cost per month in 2026?
Most people pay $0 for Part A (hospital insurance) if they or a spouse paid Medicare taxes for 10+ years. Part B (medical insurance) has a standard premium of approximately $185/month in 2026, though higher earners pay more through IRMAA surcharges. You'll also pay deductibles, copays, and coinsurance - which is why most beneficiaries add a Supplement or Advantage plan.
What's the difference between Medicare Advantage and Medicare Supplement?
Medicare Advantage (Part C) replaces Original Medicare with a private plan that often includes dental, vision, and drug coverage - usually with lower premiums but network restrictions. Medicare Supplement (Medigap) works alongside Original Medicare to cover out-of-pocket costs like deductibles and coinsurance, with no network limitations. The right choice depends on your health needs, preferred doctors, and how much predictability you want in your costs.
Does Medicare cover dental and vision?
Original Medicare (Parts A and B) does not cover routine dental, vision, or hearing care. Medicare Advantage plans often include these benefits, though coverage levels vary significantly by plan. If you have Original Medicare with a Supplement, you'd need separate standalone dental and vision policies.
Health Insurance
Learn more about health insurance →How much does health insurance cost per month?
The average unsubsidized premium for an individual ACA plan is roughly $400 to $600/month in 2026, depending on age, location, and plan level. However, most marketplace enrollees receive premium tax credits that significantly reduce this cost - many pay under $100/month. Your actual price depends on household income, family size, age, and whether you use tobacco.
What happens if I don't have health insurance?
There is currently no federal tax penalty for being uninsured, though some states (like California, Massachusetts, and New Jersey) have their own mandates. The bigger risk is financial: a single ER visit averages $2,200, and a hospital stay can exceed $30,000. Being uninsured also means you won't have access to negotiated rates that insurance companies secure with providers.
Can I get health insurance outside of open enrollment?
Yes, if you have a qualifying life event - such as losing job-based coverage, getting married, having a baby, or moving to a new state. These events trigger a Special Enrollment Period, typically lasting 60 days. Outside of these windows, you generally cannot enroll in an ACA marketplace plan until the next Open Enrollment (November 1, January 15).
What is the difference between an HMO and a PPO?
An HMO (Health Maintenance Organization) requires you to use in-network providers and get referrals from a primary care doctor to see specialists. A PPO (Preferred Provider Organization) offers more flexibility - you can see specialists without referrals and use out-of-network providers at a higher cost. HMOs typically have lower premiums, while PPOs offer broader access.
What does a health insurance deductible mean?
A deductible is the amount you pay out of pocket for covered services before your insurance starts paying. For example, with a $2,000 deductible, you pay the first $2,000 of covered medical bills yourself. After meeting the deductible, you typically pay a copay or coinsurance percentage, with the insurance company covering the rest up to your out-of-pocket maximum.
ACA Marketplace
Learn more about aca marketplace →Do I qualify for a subsidy on the ACA marketplace?
Most people with household incomes between 100% and 400% of the Federal Poverty Level qualify for premium tax credits. With enhanced subsidies currently in effect, even people earning above 400% FPL may qualify if their benchmark plan would exceed 8.5% of income. A licensed agent or Healthcare.gov can estimate your subsidy in minutes using your projected annual income.
What is the difference between Bronze, Silver, Gold, and Platinum plans?
These "metal tiers" differ in how you and the insurer split costs. Bronze plans have the lowest premiums but highest out-of-pocket costs (~40/60 split). Silver plans (~30/70) are often the best value because they unlock extra cost-sharing reductions at lower incomes. Gold (~20/80) and Platinum (~10/90) have higher premiums but lower costs when you use care.
What is a premium tax credit and how does it work?
A premium tax credit is money the government provides to lower your monthly health insurance premium on the ACA marketplace. It's calculated based on your estimated household income and the cost of the benchmark Silver plan in your area. You can apply it in advance (lowering your monthly bill) or claim it when you file your tax return.
Can I use the ACA marketplace if my employer offers insurance?
Yes, but you'll only qualify for premium tax credits if your employer's plan is considered "unaffordable" - meaning the employee-only premium exceeds about 8.39% of your household income. If your employer plan meets the affordability threshold, you can still buy a marketplace plan, but you won't receive subsidies. It's worth comparing both options before deciding.
What documents do I need to apply for ACA marketplace insurance?
You'll need Social Security numbers for everyone in your household, projected annual income (pay stubs, tax returns, or self-employment records), and information about any employer coverage available to you. Immigration documents are required for lawfully present non-citizens. Having your current doctors and prescriptions handy helps when comparing plans.
Life Insurance
Learn more about life insurance →How much life insurance do I need?
A common guideline is 10 to 15 times your annual income, but the right amount depends on your specific debts, dependents, and future goals. Consider your mortgage balance, children's education costs, your spouse's income, and how many years of income replacement your family would need. An online calculator or a licensed agent can help you estimate a more precise number.
What is the difference between term and whole life insurance?
Term life insurance covers you for a specific period (10, 20, or 30 years) and pays a death benefit only if you pass away during that term. Whole life insurance covers you for your entire life and includes a cash value component that grows over time. Term is significantly cheaper - often 5 to 10x less expensive - making it the most common choice for income replacement.
Can I get life insurance with a pre-existing condition?
Yes, though your options and pricing depend on the condition. Many conditions like controlled high blood pressure, diabetes, or a history of depression are insurable at standard or slightly higher rates. For more serious conditions, guaranteed issue or simplified issue policies don't require a medical exam, though they typically have lower coverage amounts and higher premiums.
At what age should I buy life insurance?
The younger and healthier you are, the lower your premiums will be - rates increase significantly with age. Most financial advisors recommend purchasing coverage when you take on financial responsibilities: getting married, buying a home, or having children. A healthy 30-year-old can lock in a 20-year, $500,000 term policy for roughly $25 to $35/month.
How long does it take to get life insurance?
Fully underwritten policies typically take 4 to 6 weeks, including a medical exam and records review. Simplified issue policies (no exam, just health questions) can be approved in days. Accelerated underwriting programs offered by some carriers use data and algorithms to approve healthy applicants in as little as 24 to 48 hours.
Supplemental Insurance
Learn more about supplemental insurance →What is supplemental insurance and do I need it?
Supplemental insurance pays cash benefits directly to you when you experience a covered health event - like a hospital stay, cancer diagnosis, or accident. It's designed to fill gaps that major medical insurance doesn't cover, such as deductibles, lost income, or travel costs for treatment. It's most valuable for people with high-deductible health plans or limited savings.
What does hospital indemnity insurance cover?
Hospital indemnity insurance pays a fixed daily or per-event cash benefit when you're admitted to a hospital, regardless of your other insurance. For example, a plan might pay $1,000/day for each day of hospitalization. The money can be used for anything - medical bills, mortgage payments, childcare - and is paid directly to you, not the hospital.
Is dental insurance worth it?
For most people, a basic dental plan pays for itself through two covered cleanings and an annual exam alone. Plans typically cost $20 to $50/month for individuals and cover preventive care at 100%, basic procedures at 80%, and major work at 50%. If you anticipate needing fillings, crowns, or other work, the savings can be substantial - a single crown can cost $1,000 to $1,500 without insurance.
What is the difference between critical illness and hospital indemnity insurance?
Critical illness insurance pays a one-time lump sum (e.g., $10,000 to $50,000) when you're diagnosed with a covered serious illness like cancer, heart attack, or stroke. Hospital indemnity pays a fixed amount per day or per admission for any hospitalization. Critical illness covers fewer events but pays larger amounts; hospital indemnity covers more frequent events at smaller amounts.
Can I buy supplemental insurance without having major medical insurance?
Yes - most supplemental policies (accident, hospital indemnity, critical illness, dental, and vision) can be purchased independently without a major medical plan. However, supplemental insurance is not a substitute for comprehensive health coverage. It's designed to work alongside major medical insurance to help cover out-of-pocket costs and income disruption.
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