FAQ

A health insurance agent is a licensed professional who specializes in helping individuals, families, and businesses find the right health insurance plans based on their needs and budget. They can guide you through the complexities of health insurance, helping you understand your options, compare different plans, and select the one that best fits your situation. Agents also provide ongoing support, assisting with claims, policy changes, and any questions that arise during your coverage period.

We work with a wide range of reputable insurance carriers to ensure that we can offer our clients a variety of options tailored to their needs. These carriers include Sanford, Blue Cross Blue Shield, Medica, Healthpartners, United Healthcare, Aetna, Humana, and more. By partnering with these companies, we can provide comprehensive coverage options that are reliable and competitively priced.

Health insurance is a type of coverage that helps you pay for medical expenses, including doctor visits, hospital stays, prescription drugs, and preventive care. It is essential because it protects you from high out-of-pocket costs in the event of an illness or injury, ensuring you have access to necessary medical care without financial strain. Additionally, many health insurance plans offer preventive services at no extra cost, helping you stay healthy and catch potential health issues early.

There are several types of health insurance plans available, each with its own structure and benefits. The most common types include:

• Health Maintenance Organization (HMO): Requires you to choose a primary care physician (PCP) and get referrals to see specialists. Typically offers lower premiums but less flexibility in choosing providers.
• Preferred Provider Organization (PPO): Offers more flexibility in choosing healthcare providers and specialists without needing referrals. Typically has higher premiums and out-of-pocket costs.
• Exclusive Provider Organization (EPO): A hybrid between HMOs and PPOs, EPOs offer some flexibility but require you to stay within the network for coverage.
• Point of Service (POS): Combines features of HMOs and PPOs, requiring a PCP and referrals but offering some out-of-network coverage at a higher cost.
• High-Deductible Health Plan (HDHP): Paired with a Health Savings Account (HSA), these plans have lower premiums and higher deductibles, ideal for those who want to save for future healthcare expenses.

When traveling within the U.S., most health insurance plans will still provide coverage, although the network of preferred providers may be limited depending on your location. It’s important to check with your insurance carrier about your specific plan’s out-of-network benefits and whether you need prior authorization for certain services. For international travel, some health insurance plans offer limited coverage, so it’s advisable to purchase additional travel insurance to cover any unexpected medical expenses abroad.

We offer health insurance coverage primarily in North Dakota for individuals in both North Dakota and Minnesota for businesses. Our team is well-versed in the local insurance markets, allowing us to provide tailored advice and support for residents and businesses in these regions. We are committed to helping you find the right coverage, no matter where you are located within our service area.

Premiums are the regular payments you make (usually monthly) to keep your health insurance coverage active. Paying your premium ensures that your insurance plan remains in effect, even if you don’t need medical care that month.

A deductible is the amount you must pay out-of-pocket for healthcare services before your insurance plan begins to share the costs. For example, if your deductible is $1,500, you’ll pay for the first $1,500 of covered services yourself. After that, your insurance starts covering a portion of the costs.

A copayment, or copay, is a fixed amount you pay for a specific healthcare service or prescription drug. For instance, you might pay $25 for a doctor’s visit or $10 for a prescription, with the insurance covering the rest.

Coinsurance is the percentage of costs you share with your insurance company after you’ve met your deductible. For example, if your plan has an 80/20 coinsurance, the insurance company pays 80% of the covered costs, and you pay the remaining 20%.

The out-of-pocket maximum is the most you’ll have to pay for covered healthcare services in a plan year. After you reach this limit, your insurance covers 100% of the costs for covered services for the rest of the year. This protects you from very high medical expenses and provides peace of mind.

A claim is a request for payment that you or your healthcare provider submit to your insurance company after you receive covered medical services. The insurance company then reviews the claim and pays the appropriate amount based on your coverage.

A provider is any healthcare professional, hospital, clinic, or facility that offers medical services. Providers can include doctors, specialists, nurses, and therapists. Your insurance plan may have a network of preferred providers, which can affect your costs.

In-network refers to the healthcare providers and facilities that have a contract with your insurance company to provide services at pre-negotiated rates. Using in-network providers typically results in lower out-of-pocket costs for you.

Out-of-network providers and facilities do not have a contract with your insurance company. If you receive care from an out-of-network provider, you’ll likely pay more, and in some cases, your insurance may not cover the costs at all.

A dependent is someone who relies on you for financial support and is eligible to be covered under your health insurance plan. This typically includes spouses, children, and sometimes other family members.

A Health Savings Account (HSA) is a tax-advantaged account that you can use to save money for qualified medical expenses. You can contribute to an HSA if you have a High-Deductible Health Plan (HDHP). The money in an HSA rolls over year to year, and you can use it tax-free to pay for deductibles, copayments, coinsurance, and other healthcare expenses.

In North Dakota, you generally need at least one full-time employee who is not the owner or spouse to qualify for a group health insurance plan. The definition of a full-time employee typically means someone who works at least 30 hours per week.

Yes, we use enrollment platforms to streamline the process of enrolling employees in group health insurance plans. These platforms make it easy to manage enrollments, changes, and renewals digitally.

Using an enrollment platform offers several benefits:

• Efficiency: Streamlines the enrollment process, reducing paperwork and administrative tasks.
• Accuracy: Minimizes errors in data entry and ensures accurate record-keeping.
• Accessibility: Employees can view and manage their benefits online, making it easier for them to make informed decisions
• Transparency: Employers and employees have clear visibility into plan options, costs, and coverage details.
• Time-Saving: Automates many processes, freeing up time for both HR and employees.

Offering group health insurance provides numerous benefits, including:

• Attracting Talent: Competitive health benefits can help attract and retain top talent.
• Tax Advantages: Employer contributions to group health insurance premiums are usually tax-deductible.
• Employee Well-being: Ensures your employees have access to healthcare, which can lead to a healthier, more productive workforce.
• Improved Morale: Offering health insurance shows you care about your employees’ well-being, which can boost morale and job satisfaction.
• Group Rates: Group plans often come with lower premiums and better coverage options than individual plans.

The renewal process typically begins several months before your plan’s expiration date. Your insurance provider will send you information on the renewal options, including any changes to premiums, coverage, or plan options. You can review these changes, discuss them with your agent, and decide whether to renew the current plan, make adjustments, or switch to a new plan.

You can typically change group health insurance plans during the annual renewal period. However, you may also be able to change plans mid-year if you experience a qualifying event, such as significant changes in your workforce or if your current plan no longer meets your needs.

Changing agents mid-year is possible and can be relatively straightforward. You would need to:

• Notify Your Current Agent: Inform your current agent of your decision to switch.
• Select a New Agent: Choose a new agent who can handle your group health insurance needs.
• Sign an Agent of Record (AOR) Letter: This letter officially authorizes your new agent to take over as the representative for your insurance policy. The AOR letter is submitted to the insurance company, and they will update their records to reflect the change.
• Transition Support: Your new agent will assist with the transition, ensuring there is no disruption in service or coverage for your employees.

Yes, if you or your spouse are offered an employer-sponsored group health insurance plan that is considered affordable and meets minimum value standards, you typically won’t qualify for a premium tax credit through the Health Insurance Marketplace. The Marketplace will consider your access to this plan when determining your eligibility for subsidies.

If your income increases during the year, it could reduce the amount of premium tax credit you’re eligible for through the Marketplace. It’s important to report any changes in income to your agent as soon as possible to avoid owing money when you file your taxes. If your income increases and you continue to receive a higher tax credit than you’re eligible for, you may need to repay some or all of the excess when you file your tax return.

• November 1st – Open enrollment starts
• December 15th – Last day to enroll in or change plans for coverage to start January 1.
• January 15th – Open Enrollment ends, last day to enroll in or change Marketplace health plans for the year. After this date, you can enroll in or change plans only if you qualify for a Special Enrollment Period.

To report changes to your income, address, or household, contact us if we are your agent. It’s important to report these changes as soon as they happen to ensure your coverage and any subsidies or tax credits are accurate and up-to-date.

The Health Insurance Marketplace (also known as the Exchange) is a service where individuals, families, and small businesses can shop for and enroll in affordable health insurance plans. It was created under the Affordable Care Act (ACA) to provide a centralized platform where you can compare different plans, find out if you qualify for subsidies or tax credits, and purchase health insurance coverage.

You can apply for coverage through the Health Insurance Marketplace online, by phone, by mail, or in person with the help of an enrollment assistant or navigator. During the open enrollment period, you’ll fill out an application that includes information about your household, income, and any current coverage, and the Marketplace will determine your eligibility for subsidies, Medicaid, or other assistance programs.

If you miss the enrollment period, you won’t be able to purchase health insurance through the Marketplace until the next open enrollment period unless you qualify for a Special Enrollment Period (SEP). SEPs are triggered by qualifying life events such as marriage, birth of a child, loss of other coverage, or a significant change in income.

If you don’t qualify for special enrollment, you might have limited options. You can:

• Consider short-term health insurance: These plans are designed to provide temporary coverage and may be available year-round, though they offer more limited benefits.
• Look into Medicaid or CHIP: If your income is low enough, you might qualify for Medicaid or the Children’s Health Insurance Program (CHIP), which has year-round enrollment.
• Wait for the next open enrollment period: You may need to wait until the next open enrollment period to sign up for a full health insurance plan.

Subsidies and tax credits are financial assistance programs designed to help lower the cost of health insurance premiums and out-of-pocket expenses for individuals and families who purchase coverage through the Health Insurance Marketplace:

• Premium Tax Credits: These are available to individuals and families with incomes between 100% and 400% of the federal poverty level (FPL). They reduce the cost of your monthly premiums.
• Cost-Sharing Reductions (CSRs): These lower the amount you pay out-of-pocket for deductibles, copayments, and coinsurance, and are available to those with incomes between 100% and 250% of the FPL, but only if you choose a Silver plan through the Marketplace.

Medicare consists of four main parts:

• Part A: Hospital Insurance, which covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
• Part B: Medical Insurance, which covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
• Part C: Medicare Advantage, which is an alternative to Original Medicare offered by private insurance companies. It includes Parts A and B and often additional benefits like dental, vision, and hearing coverage.
• Part D: Prescription Drug Coverage, which helps cover the cost of prescription medications.

If you miss your Initial Enrollment Period (IEP) when you first become eligible for Medicare, you may have to wait until the General Enrollment Period (January 1 to March 31 each year) to sign up. Additionally, you may face a late enrollment penalty for Part B and Part D if you don’t have other creditable coverage. This penalty increases your premiums for as long as you have Medicare.

You can make changes to your Medicare coverage during the Annual Enrollment Period (AEP) from October 15 to December 7 each year. During this time, you can switch between Original Medicare and Medicare Advantage, change Medicare Advantage plans, or join or switch to a Medicare Part D prescription drug plan. There’s also a Medicare Advantage Open Enrollment Period from January 1 to March 31, during which you can switch Medicare Advantage plans or revert to Original Medicare.

You can enroll in Medicare online through the Social Security Administration’s website, by phone, or by visiting your local Social Security office. If you’re already receiving Social Security benefits when you turn 65, you’ll be automatically enrolled in Medicare Parts A and B. If not, you need to sign up during your Initial Enrollment Period, which begins three months before you turn 65, includes your birthday month, and extends three months afterward.

Medicare Part A is Hospital Insurance. It covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services.

For most people, Part A is premium-free if you or your spouse paid Medicare taxes for at least 10 years (40 quarters) while working. If you don’t qualify for premium-free Part A, you can buy it by paying a monthly premium. However, even with premium-free Part A, there are costs such as deductibles and coinsurance for the services you receive.

Medicare Part B is Medical Insurance. It covers outpatient care, doctor visits, preventive services, and medical supplies.

Part B covers medically necessary services like doctor visits, outpatient care, home health services, and preventive services such as screenings and vaccines. Unlike Part A, Part B is not free. You pay a monthly premium, which is based on your income, as well as an annual deductible and typically 20% of the cost of services after your deductible is met.

Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurance companies approved by Medicare. It bundles Part A, Part B, and usually Part D (prescription drug coverage) into one plan. Medicare Advantage plans often include additional benefits that Original Medicare doesn’t cover, such as vision, dental, hearing, and wellness programs. However, Medicare Advantage plans may have more restrictions on which healthcare providers you can use.

Medicare Part D provides prescription drug coverage. It helps cover the cost of prescription medications and is available through private insurance companies approved by Medicare.

Part D plans have a formulary, which is a list of covered drugs organized into tiers. Each tier has a different cost, with generic drugs usually on the lowest tier. You pay a share of the cost through copayments or coinsurance. Part D plans also have a coverage gap (often called the “donut hole”), where you may pay more out-of-pocket for your drugs after reaching a certain spending limit. However, catastrophic coverage kicks in once your out-of-pocket costs reach a certain threshold, significantly reducing your costs for the rest of the year.