Best Health Insurance Agencies in Allentown, PA

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.
  

• Under the No Surprises Act, what healthcare providers must never balance a bill in Allentown?

  Emergency room providers, pathologists, anesthesiologists, and assistant surgeons must never balance a bill. Similarly, professionals such as neonatologists, radiologists, intensivists, and hospitalists must not do so. Bills from HHS-identified specialty providers and for diagnostic services, excluding advanced tests, are also covered under the No Surprises Act. A plan holder in Allentown must be billed in good faith when an out-of-network provider is sought because no in-network provider is available.

• Can one who is incarcerated in Allentown buy a plan from the state's online health insurance marketplace, Pennie?

  No. An incarcerated person cannot buy from the state's online health insurance marketplace, Pennie. Incarcerated means serving a term at a public prison institution following a conviction and does not include those awaiting disposition of charges and under home arrest, parole, or probation. Persons in Allentown held in prison but not yet convicted can buy insurance online.

• For consumers in Allentown, why did the out-of-pocket premiums increase a lot higher for the upcoming year?

  Consumers in Allentown may have higher increases in out-of-pocket premiums for the upcoming year because of the cost changes of the benchmark plan in the metro. Due to the benchmark plan's cost changes, the premium tax credit may also change. Other factors that may affect how much consumers must pay are where they live and the metal-tier coverage they choose.

• What other government-sponsored programs can you apply in Allentown if you do not qualify for Medicaid?

  HealthChoices and the Medical Assistance Transportation Program are options for individuals ineligible for Medicaid. Certain groups can apply for programs such as Medical Assistance for Children and Pregnant Women and Medical Assistance Benefits for Workers with Disabilities. There are also programs for mental health and substance abuse disorders, reproductive health, and prescription drug coverage. Details on these programs can be obtained from the Lehigh County Assistance Office at 555 Union Blvd., Suite 3, Allentown, PA 18109-3389. The office can be reached at 610-821-6509 or through the toll-free number at 1-877-223-5956.

• How does coinsurance work for an insured in Allentown?

  Coinsurance is the amount an insured individual in Allentown must pay for a covered claim after the deductible has been reached. It is expressed as a percentage of a breakdown—for example, 80/20, wherein the insurance company pays 80% and the insured 20%. Most health plans come with maximum limits for out-of-pocket expenses, such as deductibles and coinsurance, that the insured must pay for the benefits under a certain period.

• 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.