Best Health Insurance Agencies in Visalia, CA

FAQs

• Introduction

  If you're looking for health insurance for yourself or your family, an agent can help you save time, understand your options, and manage your costs. Insurance agents must be licensed in the state where they operate. They can provide information about on- and off-exchange plans to help you weigh all of your options, and they can see if you qualify for tax credits that can lower your monthly premiums. There's no cost to work with an agent, and they can help you save quite a bit by recommending the best plan for your needs. Here's what you should know before you get started.
  

• How can healthcare providers in Visalia resolve disputes with their insureds?

  In Visalia, before filing a complaint with the California Department of Insurance (CDI), healthcare providers must first address the issue in writing through the insurer's Dispute Resolution Mechanism. If a provider is dissatisfied with the outcome, he or she may file a complaint with the CDI by completing a Health Care Provider Request for Assistance (HPRFA) form. Separate forms are required for each complaint. Visit their website if you want to file electronically or access printable forms.

• What should Visalia residents do if they lose their health coverage?

  Those who lose employer-based coverage in Visalia can look into Continuation Coverage programs like COBRA, Cal-COBRA, or HIPAA to extend their existing benefits or find new coverage on their own. Individual or family policies are difficult to cancel, but insurers can do so for intentional misrepresentation or unpaid premiums. Residents facing wrongful cancellation can seek help from the California Department of Insurance's consumer hotline at 1-800-927-4357.

• How do metal levels guide Visalia residents in choosing health insurance plans?

  In Visalia, insurance plans use metal levels to denote coverage: bronze, silver, gold, and platinum. Bronze covers 60% of health-care costs, Silver 70%, Gold 80%, and Platinum 90%. Each tier has its own out-of-pocket maximum. Residents should base their decision on their health needs, with the understanding that a higher-tiered plan may be more cost-effective for those who require regular care.

• Are the 10 essential health benefits included in all insurance plans in Visalia?

  On-exchange insurance plans in Visalia guarantee coverage of the ten essential health benefits mandated by the Affordable Care Act. These benefits establish a minimum level of care, ensuring complete protection. Medical expenses can be overwhelming without such coverage, potentially causing financial distress. Choosing an on-exchange plan ensures this critical safeguard against skyrocketing healthcare costs.

• What is a Good Faith Estimate and how does it benefit patients in Visalia?

  Patients in Visalia who do not have health insurance or who do not use their insurance have the right to a written Good Faith Estimate from their health care providers outlining the expected costs for non-emergency medical items or services. This includes costs such as tests, drugs, and hospitalization. Patients can challenge the charge if the final bill exceeds the estimate by $400 or more.

• How can you find affordable health insurance? 

  Affordable insurance is available through employers, Medicare, Medicaid, and the federal Health Insurance Marketplace, which offers subsidies in the form of tax credits. You can also purchase coverage through private insurance companies and independent agents. Nearly half of all Americans have employer-sponsored health insurance, and about 10% of the population is uninsured.

• What is health insurance?

  Health insurance policies are contracts that require an insurer to pay some or all of a beneficiary's health care expenses in exchange for a premium and deductible. Plans cover preventive care and emergency medical services arising from an injury or illness. They may also offer optional coverage for dental and vision.

• How do health insurance companies make money?

  Health insurance companies make money by collecting premiums from consumers and reinvesting the funds. Federal law requires insurers to put approximately 80-85% of collected funds toward claims, and 15-20% is used to pay for administrative expenses.

• What is subsidized health insurance?

  Subsidized health insurance is available exclusively through the Health Insurance Marketplace. This system applies federal tax credits that can reduce or eliminate premiums. Tax credits are available to consumers who earn up to 400% of the federal poverty level based on household size.

• What is a health insurance deductible? 

  A deductible is a fixed amount you must pay out-of-pocket before normal copays or coinsurance rates apply. Under the Affordable Care Act, some services, such as annual physicals and wellness screenings, must be covered at no charge.

• Is it illegal to not have health insurance?

  No. Starting in 2019, the federal government eliminated the penalty that applied to individuals who could afford health insurance but chose not to purchase it. Financial penalties still apply in California, Massachusetts, New Jersey, Rhode Island, Vermont, and Washington, D.C.

• Does health insurance cover therapy? 

  All Marketplace plans must cover behavioral health care services, including counseling, inpatient care, and substance abuse treatments. However, there are coverage limits, and preauthorization may be required.
  

• What is a copay?

  A copay is a fixed price that you pay at the time of service after your deductible is satisfied. Insurance companies set specific rates for primary and specialty care and other services, such as emergency room visits and X-rays. Alternatively, plans may have coinsurance rates that require beneficiaries to pay a certain percentage of covered charges.

• What is the Health Insurance Marketplace?

  The Health Insurance Marketplace is a federal service designed to help consumers compare and purchase subsidized health insurance plans that comply with the Affordable Care Act. A number of states operate their own insurance marketplaces, including California, Colorado, New York, and Pennsylvania.
  

• How can you find health insurance without a job?

  Individuals who don't have access to health insurance through their job can purchase ACA-compliant plans through the Health Insurance Marketplace. Off-exchange plans are also available through private insurers and independent agents. The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives certain individuals who are losing their coverage the right to maintain the same plan for a limited time period. 
  

• Can you cancel health insurance at any time? 

  Consumers can cancel their health coverage at any time. Cancellations may be effective immediately or at a specified date. However, you must wait until Open Enrollment to sign up for a new plan unless you qualify for a Special Enrollment period.

• Can you have more than one health insurance policy?

  It's possible to have primary and secondary health insurance. This is most common with Medicare and Medicaid beneficiaries, including dual enrollees and individuals who purchase supplemental plans. Secondary plans can cover some additional expenses, but you're still responsible for premiums and deductibles.

• Is health insurance pretax?

  Premiums for employer-sponsored health plans are generally deducted from the worker's pretax income. The same is true for voluntary contributions made to Flexible Spending Accounts and Health Savings Accounts that are paired with a qualifying high-deductible health plan.

• How long can a child stay on a parent\'s health insurance policy?

  Children can stay on their parents' health insurance plan until their 26th birthday. There's a 60-day special enrollment period following this date. Exemptions allow disabled adult children to remain on their parents' policy beyond this age.

• Do you have to pay a health insurance deductible upfront?

  In most cases, out-of-pocket expenses for approved services count toward your deductible. However, it's increasingly common for hospitals to request all or part of the deductible upfront when scheduling major services, such as CT scans and surgeries.

• Do employers have to offer health insurance?

  The Affordable Care Act requires companies with at least 50 full-time employees to make essential health benefits available to 95% of their workforce. Companies that choose not to offer such benefits may have to pay a penalty.

• Is there a tax credit for having health insurance?

  The Advance Premium Tax Credit is a federal tax rebate designed to lower the cost of health insurance plans purchased through the Marketplace. Eligibility is based on income and household size. Consumers can decide how much of their tax credit to put toward their premiums.