Best Health Insurance Agencies in Silver Spring

Frequently Asked Questions

• 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.
  

• Are companies in Silver Spring required to provide their employees with health insurance?

  This is determined by the size of the business. Employers in Silver Spring with 50 or more employees must provide health insurance to their employees and their dependents. However, if a company has fewer than 50 employees, it is not required to provide healthcare benefits. If, on the other hand, the employer decides to provide healthcare benefits, it will be eligible for tax credits.

• Will your Health Maintenance Organization plan be charged if you have an emergency from an out-of-network provider in Silver Spring?

  The Health Maintenance Organization (HMO) is a type of Silver Spring health insurance that pays for care provided by doctors who work for or contract with the HMO. This means that it typically only covers care provided by HMO-accredited providers. Unless it is an emergency, most HMO plans will not cover care from an out-of-network provider. In addition, policyholders are protected from unexpected medical bills as a result of receiving out-of-network care at an in-network facility for emergency services.

• Do you have to pay anything if you received healthcare from a Silver Spring Health Maintenance Organization plan-accredited provider?

  Aside from deductibles and copayments, enrollees in a Silver Spring Health Maintenance Organization (HMO) plan are not required to pay a provider for covered services. If the policyholder receives healthcare from a non-contract provider, the policyholder must pay, and the HMO will only reimburse. Some HMO plans include a point-of-service option in which out-of-network providers accept the HMO plan and the policyholder must pay the difference between the HMO payment and the amount billed by the provider.

• Can you see doctors and other providers who are not part of your Preferred Provider Organization (PPO) plan in Silver Spring?

  Yes, you can see doctors and other providers in Silver Spring who are not part of your Preferred Provider Organization (PPO) plan. PPO is a type of health insurance that allows policyholders to use doctors, hospitals, and providers outside of the network for a fee. PPO plans also have partnerships with certain healthcare providers, so if you choose to use their services, you will pay less.

• What happens if your health insurance carrier in Silver Spring denies medical expenses or treatment that’s covered by your policy?

  If your health insurance provider in Silver Spring denies coverage for medical expenses or treatment outlined in your policy, they must issue a written statement. This document should include information about internal grievance and appeals process, allowing you to file an appeal if necessary. The Maryland Attorney General's Health Education and Advocacy Unit (HEAU) provides free mediation services when appealing benefit denials. You can also hire an independent medical expert or an independent review organization (IRO) to assess the medical necessity of recommended healthcare services.

• 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.