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Can I get Health Coverage Outside Open Enrollment?


With a Special Enrollment Period. You can qualify if you lose job-based coverage, have a baby, get married, or have certain other life changes, or based on estimated household income.

Through Medicaid or the Children's Health Insurance Program (CHIP). You can apply any time and can enroll immediately if you're eligible.

How Health Insurance Works

Have questions about how health insurance works? You've come to the right place. We've covered the basics of health insurance for you below. We explain the differences between deductibles, coinsurance and copays, in-network and out-of-network benefits, HMO and PPO plans.


Deductible: A deductible is the amount of money you must pay out of pocket before your health insurance coverage starts paying for medical services. For example, if you have a $1,000 deductible, you need to pay the first $1,000 of covered medical expenses before your insurance begins covering its share.


Coinsurance: Coinsurance refers to the percentage of costs you share with your insurance provider after meeting your deductible. Once you've paid your deductible, your insurance plan will typically cover a percentage (e.g., 80%) of the allowed amount for covered services, and you'll be responsible for paying the remaining percentage (e.g., 20%).


Copay: A copay is a fixed amount you pay for specific medical services or prescriptions at the time of receiving care. Unlike coinsurance, a copay doesn't depend on the total cost of the service. For example, you might have a $30 copay for a doctor's office visit or a $10 copay for generic prescriptions.


In-network and out-of-network benefits: Health insurance plans often have a network of preferred providers, including doctors, hospitals, and other healthcare professionals. In-network refers to those providers who have contracted with your insurance plan to provide services at discounted rates. If you visit an in-network provider, your insurance plan will typically offer higher coverage levels and lower out-of-pocket costs. Out-of-network providers are not contracted with your insurance plan, and visiting them may result in higher costs for you, with less coverage from your insurance plan.


HMO (Health Maintenance Organization) plans: HMO plans typically require you to select a primary care physician (PCP) from their network, and you must get referrals from your PCP to see specialists. HMO plans generally have lower premiums and out-of-pocket costs but offer less flexibility in choosing healthcare providers. Out-of-network benefits are typically limited or not covered except in emergencies.


PPO (Preferred Provider Organization) plans: PPO plans offer more flexibility in choosing healthcare providers. You can see specialists directly without a referral, and you have the option to visit both in-network and out-of-network providers. In-network care will usually have lower out-of-pocket costs, while out-of-network care will have higher costs. PPO plans tend to have higher premiums compared to HMO plans.

It's important to note that the specifics of deductibles, coinsurance, copays, in-network, and out-of-network benefits can vary depending on your insurance plan, so it's crucial to review the details of your specific policy to understand how it works and what costs you can expect.


Where Can I Find 2023 Marketplace Plans?

Our team of specialists have access to thousands of Marketplace plans. Answer a few quick questions to preview plans with personalized price estimates before you apply. Click here to begin your health insurance search.

Are health insurance premiums tax deductible?

Health insurance premiums are deductible if you itemize your tax return.  If you pay for health insurance before taxes are taken out of your check, you can't deduct your health insurance premiums.

 How do I pay my monthly premium to complete enrollment?

When you have Marketplace insurance, you'll pay your premiums directly to the insurance company — not to the Health Insurance Marketplace®. Your coverage won't start until you pay your first premium.

Why is health insurance important?

Health insurance protects you from unexpected, high medical costs. The amount you pay for covered health care services before your insurance plan starts to pay.

What happens if health insurance denies a claim?

If your health insurer refuses to pay a claim or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party.

You can ask that your insurance company reconsider its decision. Insurers have to tell you why they’ve denied your claim or ended your coverage. And they have to let you know how you can dispute their decisions.

How do deductibles work?

The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.

After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. Your insurance company pays the rest.

Generally, plans with lower monthly premiums have higher deductibles.

Information Resource Center

Regardless of whether you are looking for health insurance for individuals or health insurance for family members, we understand that a lot of people have questions. Some of the most common questions we hear about individual and family medical insurance include:

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Individual & Families

Find out all the information you need to know about individual health insurance and family health plans from The Health Insurance Group.

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Affordable Care Act

Learn more about Obamacare plans, information about the Affordable Care Act, and how it affects you and those 
you over.

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Dental & Vision

Explore Information about dental/vision coverage and get more information on how to find an affordable dental/vision plan.

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Life Insurance

Life insurance policies can be confusing - find all the resources you need to understand wheter or not this coverage is right for you.

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Carriers That Care

A few of the leading carriers we work with, giving you the best options!

Our Carriers

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Carriers That Care

A few of the leading carriers we work with, giving you the best options!

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