Frequently Asked Questions

Insurance terminology is confusing — health insurance especially so. Here's the plain version:

• Copay: A fixed amount you pay for a covered service (doctor visits, prescriptions) regardless of your deductible.
• Deductible: The amount you pay out-of-pocket before your insurance kicks in for hospital, surgery, ER, and diagnostic services. Higher deductible = lower monthly premium.
• Co-insurance: After your deductible is met, costs are split between you and the insurer (e.g., 80/20 means they pay 80¢ of every dollar, you pay 20¢).
• Maximum Out-of-Pocket: The most you'll ever pay in a plan year. Once you hit it, the plan covers 100% of eligible in-network costs for the rest of the year.

Most plans have both individual and family deductibles and out-of-pocket maximums.

We work hard to make sure our clients have access to the doctors and hospitals they want. Different carriers work with different provider networks. We take the time to evaluate the available networks to find the best fit for you specifically.

The ACA provides subsidies (APTCs) to help people who buy coverage on their own — but eligibility depends on income and whether you have access to affordable employer-based coverage. People who qualify for Medicare, VA benefits, or Medicaid generally cannot use ACA subsidies. Taking subsidies incorrectly can mean paying them back at tax time, plus penalties. We help clients do this the right way.

The federal individual mandate penalty was reduced to $0 starting in 2019 — so most people face no federal tax penalty for going uninsured. However, the mandate itself technically remains, and some states have their own penalties. More importantly, going without coverage carries real financial risk. We're happy to walk through your options.

Health insurance purchased through the Federally Facilitated Marketplace (ACA plans) cannot deny coverage or charge more based on pre-existing conditions. Your conditions are covered from Day 1. This is one of the most important protections the ACA put in place.

That's exactly where we come in. In Sedgwick County alone, there are dozens of plans across multiple carriers. We have systems to help you cut through the noise — comparing networks, prescriptions, costs, and coverage — so you end up with the plan that gives you the experience you want at a price that works for your budget.

Most employers stopped contributing toward family member premiums years ago — so adding a family to a group plan can be eye-watering. Many families find they can get better coverage at lower cost through the individual market. We'll look at ACA plans, off-exchange private plans, sharing programs, and Direct Primary Care options to find a solution — sometimes a blend of options — that gives you the coverage you want at a price that actually works.