General FAQS
What if I don't live in a state where you have agents or an office? Can you still help me?
Yes, give us a call. If we don't have an agent in your area, we will direct you to someone who can help you.
Do you only work in person or can you help virtually?
We are able to serve our customers in person and virtually.
Why should I use an independent insurance agent instead of shopping on my own?
Enrolling in health insurance can be done on your own, but there are significant benefits to working with an independent agent/broker like us. Here’s why many clients find our assistance valuable:
Expert guidance through complex choices: Health insurance (Medicare and ACA alike) is complex – there are tons of plans, coverage rules, and industry jargon. As experienced agents, we educate you on your options and explain coverage in plain language.
Time and hassle savings: Rather than you having to research dozens of plans, check which doctors are in network, figure out formulary details, and fill out enrollment forms, we handle that for you. We’ll compare plans from different insurers quickly using our tools and knowledge. We’ll also do the enrollment paperwork or online application on your behalf (with your information). This saves you hours and ensures things are done correctly. No need to wait on hold with Healthcare.gov or Medicare – we do these every day and know the process inside out.
Access to multiple carriers & unbiased advice: As mentioned, we have a wide view of the market. If you go to a single insurance company’s site, you only see their plans. If you go to the public Marketplace site alone, you see options but might not be sure how to filter them well. We bring an insider perspective – we already know which plans have strong networks in our area, which carriers have good customer service or certain benefits, etc. We’ll lay out the top choices impartially.
Enrollment and beyond: We don’t just drop you after enrollment. As described in earlier answers, we provide ongoing support – you can call us anytime with issues. If you sign up by yourself through an exchange or direct, you might end up calling a generic customer service line when you have problems, whereas with us, you call us and get personalized help. We essentially become your advocate year-round.
Avoiding pitfalls and ensuring completeness: We make sure things like effective dates are correct, subsidies are applied properly, and that you’re aware of important deadlines (for example, submitting any required documents to the Marketplace, or the Medicare timelines). It’s easy for a layperson to overlook a detail that could cause a gap in coverage or a loss of subsidy. We’ve got your back on those technicalities.
Does it cost anything to work with your agency? How are you compensated?
No, our agency does not charge clients any fees. We get compensated by insurance carriers, so our advice and service come at no additional cost to you.
What kind of support do you provide after I’ve enrolled in a plan (e.g., with claims or billing issues)?
Our agency’s job isn’t finished once you enroll – we continue to be your advocate and point of contact for any issues or questions that arise with your insurance. Here are ways we support you post-enrollment: Claims and billing assistance, Answering coverage questions, Policy changes and updates, Advocacy and issue resolution.
Can you help my aging parents find health coverage (like Medicare)?
Absolutely! We specialize in Medicare plans and can guide your parent(s) through their initial enrollment, explain their options, and help them avoid penalties. If your parent already has Medicare but needs help reviewing or changing their plan (maybe during the Annual Medicare Open Enrollment), we can assist with that too. Adult children often come to us with concerns that a parent’s current Medicare Advantage or Part D plan isn’t meeting their needs. We’re happy to do a plan review and, if appropriate, help switch to a better option during the proper enrollment period.
Do you operate locally or serve clients in multiple states?
We operate locally in several states. We have agents in Louisiana, Mississippi, Alabama, Florida, Georgia, Texas, Virginia and Wisconsin.
Are there any unique services or value-adds your agency offers (like plan reviews, annual check-ins, concierge support)?
We believe that once you choose us as your agent, we are your agent for life and are available to you to answer any questions you have or needs that may arise.
What types of clients do you primarily serve (e.g., seniors, families, small businesses)?
Our primary clients are seniors and Medicare-eligible individuals who are looking for guidance with Medicare. Because we specialize in Medicare, we often work with people as they approach age 65 (or those eligible due to disability) to navigate their Medicare choices. However, we also serve individuals and families of all ages for other insurance products – for example, people under 65 who need health insurance, or anyone seeking life insurance and supplemental coverage. Whether you’re a Medicare beneficiary, a retiree, a small business owner, or a family needing coverage, we tailor our advice to your unique situation.
Medicare FAQS
How do I protect myself from Medicare fraud and scams?
To stay safe from Medicare fraud and scams:
Never share your Medicare number or personal information with strangers or unsolicited callers.
Review your Medicare Summary Notice or Explanation of Benefits regularly for any unfamiliar charges.
Be wary of offers for “free” medical supplies or tests if they require your Medicare number.
Report any suspicious activity to Medicare at 1-800-MEDICARE or contact the Senior Medicare Patrol.
Stay informed and alert—protecting your information is key to avoiding scams and fraud!
Where can I find help with Medicare questions?
You can find personalized help with Medicare through several resources:
The official Medicare website offers extensive information, plan finders, forms, and contact information.
You can call Medicare directly at 1-800-MEDICARE (1-800-633-4227) for general questions and support.
The State Health Insurance Assistance Program (SHIP) provides free, unbiased counseling to help individuals understand Medicare options and rights.
Local senior centers or agencies on aging may also provide assistance.
How do I appeal a denial of coverage?
You can appeal a denied claim by following the steps outlined in your denial letter or on your Medicare Summary Notice. The appeals process usually involves several levels—starting with a “Redetermination” (a review by Medicare), and if needed, proceeding to higher levels of appeal. Detailed instructions and forms for appeals can be found on the Medicare appeals page.
What can I do if my claim is denied?
If your Medicare claim is denied, review your Medicare Summary Notice or the denial letter to understand the reason. Sometimes, an error or missing information can be corrected by contacting your provider or Medicare directly. If you still disagree with the decision, you have the right to appeal.
How do I file a Medicare claim?
In most cases, your healthcare provider will file Medicare claims for you. However, if your provider does not file a claim, you can submit one yourself by completing the Medicare claim form (CMS-1490S) and mailing it to your Medicare Administrative Contractor along with an itemized bill and supporting documents. Instructions and the claim form are available on the official Medicare website.
What preventive services are covered?
Medicare covers a wide range of preventive services at little or no cost, including:
Annual “Wellness” visits
Many vaccinations (such as flu and pneumonia)
Screenings for cancer (colorectal, breast, prostate), diabetes, and cardiovascular conditions
Bone density measurements, depression screenings, and certain counseling and education programs
A full list of covered preventive services and eligibility guidelines can be found on the official Medicare site.
Does Medicare cover long-term care or nursing homes?
Medicare does not cover custodial long-term care (such as assistance with bathing, dressing, or eating) in a nursing home or assisted living facility. However, Medicare may pay for short-term skilled nursing facility care after a hospital stay or for medically necessary home health or hospice care. For ongoing long-term care needs, other insurance or state Medicaid may be required.
Are prescription drugs covered under Medicare?
Prescription drugs are not covered by Original Medicare. To receive prescription drug coverage, you must enroll in a stand-alone Medicare Prescription Drug Plan (Part D) or a Medicare Advantage plan (Part C) that includes drug coverage. Each plan has its own formulary, costs, and pharmacy network.
Does Medicare cover dental, vision, or hearing?
Original Medicare (Parts A & B) generally does not cover routine dental care, vision exams, eyeglasses, or hearing aids. However, some Medicare Advantage (Part C) plans may include limited coverage for dental, vision, and hearing services. Always review specific plan details to see what’s included.
How do I choose a Medicare prescription drug plan (Part D)?
Choosing a Medicare Part D plan involves comparing options based on:
The medications you take and whether they’re covered (the plan’s formulary)
Monthly premiums, deductibles, and copayments
Preferred pharmacy networks
Star ratings or reviews for customer satisfaction
You can use the official Medicare Plan Finder tool to compare prescription drug plans in your area based on your specific medication needs. It’s also wise to check each plan’s formulary before enrolling to be sure your prescriptions are included.
What are Medicare Supplement (Medigap) policies?
Medigap policies are optional private insurance plans designed to “fill the gaps” in Original Medicare coverage, like copayments, coinsurance, and deductibles. Medigap works only with Original Medicare (not with Medicare Advantage) and is regulated to standardize what each plan must cover. Medigap does not include prescription drug coverage—if you want that, you will need to add a separate Part D plan.
What is the difference between Original Medicare and Medicare Advantage?
Original Medicare is the traditional government-run Medicare program, consisting of Part A (hospital insurance) and Part B (medical insurance). It allows you to see any provider nationwide who accepts Medicare, and you pay standardized deductibles and coinsurance. Prescription drug coverage (Part D) and supplemental coverage (Medigap) must be added separately.
Medicare Advantage (Part C) plans are offered by private insurance companies. They cover all services under Parts A and B and often include additional benefits like prescription drug coverage, dental, vision, and wellness programs. These plans usually have provider networks and may have different out-of-pocket costs and coverage rules compared to Original Medicare.
Does Medicare cover all medical expenses?
No, Medicare does not cover all medical expenses. While it helps pay for many healthcare services, you’re still responsible for things like premiums, deductibles, copayments, and some services not covered (such as most dental, vision, and hearing care, and long-term custodial care). You may want to consider additional Medigap (supplemental) insurance or other coverage to help pay those costs not covered by Medicare.
How can I pay my Medicare premiums?
You can pay your Medicare premiums in several ways:
Automatic deduction from your Social Security benefit
Direct payment using Medicare Easy Pay (an automatic deduction from your bank account)
Mailing a check or money order to Medicare
Paying online through your Medicare account with a credit or debit card
What are Medicare premiums, deductibles, and copayments?
Premiums: These are monthly payments for Medicare coverage. Most people pay a premium for Part B and, if applicable, Part D (prescription drug coverage), and sometimes for Part A if they don't qualify for free Part A.
Deductibles: This is the amount you pay out-of-pocket for healthcare before Medicare starts to pay its share. Each part of Medicare has its own deductible.
Copayments (or coinsurance): After meeting your deductible, you are responsible for a share of the costs for services. This is usually a set dollar amount (copayment) or a percentage of the bill (coinsurance).
Can I sign up for Medicare if I have other health insurance?
Yes, you can enroll in Medicare even if you have other health insurance, such as employer group coverage, retiree coverage, or COBRA. In some circumstances, Medicare may serve as your secondary insurance, helping to cover costs not paid by your primary plan. It’s important to understand how Medicare will work with your current coverage and avoid gaps in protection.
What happens if I miss my enrollment window?
If you miss your Initial Enrollment Period and do not qualify for a Special Enrollment Period, you may need to wait until the General Enrollment Period (January 1 to March 31 each year) to sign up. Coverage starts July 1, and you may have to pay a late enrollment penalty, resulting in higher premiums for as long as you have Medicare.
How do I enroll if I am still working at 65?
If you’re still working and have employer health coverage at age 65, you can choose to delay enrolling in Medicare Part B (and Part D, if applicable) without facing a late enrollment penalty, as long as your employer coverage qualifies. Once your employment or coverage ends, you’ll have a Special Enrollment Period (typically eight months) to enroll in Part B.
At what age can I sign up for Medicare?
You are eligible to sign up for Medicare when you turn 65. Enrollment typically begins three months before your 65th birthday and extends three months after, giving you a seven-month Initial Enrollment Period.
How much does Medicare cost?
Part A: Usually no monthly premium if you or your spouse paid Medicare taxes while working. Deductibles and coinsurance may apply.
Part B: Most people pay a standard monthly premium, which can change annually, plus deductibles and coinsurance.
Part C and D: These are offered by private insurers and costs vary based on the plan selected—this includes premiums, deductibles, copayments, and coverage choices (such as prescription drugs).
What does Medicare cover and not cover?
Medicare covers many medically necessary services, but not everything:
Covered: Hospital stays, doctor visits, preventive services, lab tests, some home health care, some durable medical equipment, and prescription drugs (with Part D or a Medicare Advantage plan).
Not Covered: Most dental care, routine eye exams, hearing aids, long-term care, and cosmetic surgery.
When does Medicare coverage start?
For most people, Medicare coverage begins the first day of the month you turn 65, provided you signed up during the three months before your birthday month. Coverage may start later if you enroll after your birthday month.
How do I enroll in Medicare?
Most people are automatically enrolled in Original Medicare (Parts A and B) around their 65th birthday if they are already receiving Social Security benefits. Otherwise, you can sign up for Medicare through the Social Security Administration’s website, by phone, or in person. There's a seven-month Initial Enrollment Period: three months before, the month of, and three months after your 65th birthday.
What are the different parts of Medicare (A, B, C, D)?
Part A (Hospital Insurance): Covers inpatient hospital stays, care in skilled nursing facilities, hospice care, and some home health care.
Part B (Medical Insurance): Covers outpatient care such as doctor visits, preventive services, lab tests, outpatient surgeries, and medical supplies.
Part C (Medicare Advantage): Optional plans offered by private insurers that cover all Part A and B services, and usually Part D as well. Many plans include extra benefits like vision, dental, and wellness programs.
Part D (Prescription Drug Coverage): Helps cover the cost of prescription medications.
Who is eligible for Medicare?
Eligibility typically includes:
Individuals age 65 and older
People under 65 with specific disabilities who have received Social Security Disability Insurance (SSDI) for 24 months
People of any age with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis (ALS)
What is Medicare?
Medicare is a federal health insurance program in the United States primarily designed for people age 65 and older, but it also serves certain younger individuals with disabilities and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).
Insurance FAQS
How do I file a claim for ancillary benefits?
To file a claim, follow these steps:
Notify your insurance provider as soon as you have a qualifying event or receive services.
Obtain claim forms from your provider’s website or customer service.
Submit completed forms, along with any supporting documents (like an explanation of benefits, bills, or diagnosis confirmation).
Your insurer will review the claim and issue payment if approved.
For more information, always check your individual policy or ask your insurance company or HR department for help with filing ancillary insurance claims.
What is critical illness insurance and what does it cover?
Critical illness insurance provides a lump-sum payment if you are diagnosed with a covered serious condition such as cancer, heart attack, stroke, or other severe illnesses. This benefit can help pay for out-of-pocket medical costs, household expenses, or lost income during treatment and recovery.
How do I add supplemental coverage?
You can add ancillary (supplemental) coverage by:
Purchasing standalone policies from an insurance provider
Enrolling during your employer’s open enrollment period if offered through work
Adding riders to your existing health plan (if available)
It's important to compare plan benefits to ensure you get the right supplemental coverage for your needs.
Is vision or hearing covered under my health plan?
Most standard health insurance plans do not fully cover routine vision or hearing services. You typically need separate vision and hearing insurance, or choose a health plan with built-in vision or hearing benefits. Always review your policy details or contact your insurer to verify specific coverage.
What types of ancillary coverage are available?
Common ancillary insurance types include:
Vision insurance (eye exams, glasses, contact lenses)
Dental insurance
Hearing insurance (hearing exams, hearing aids)
Accident insurance (pays cash for accidental injuries)
Disability insurance (provides income if you cannot work due to illness or injury)
Critical illness insurance (lump sum payment if diagnosed with a serious condition like cancer, heart attack, or stroke)
Hospital indemnity plans
What is ancillary insurance?
Ancillary insurance refers to supplemental coverage that goes beyond standard health insurance. It helps cover specific services or needs that primary medical insurance may not fully address, such as vision, dental, hearing, disability, and more.
How are dental claims processed?
When you receive dental care, your provider typically submits a claim directly to your insurance company. The insurer reviews the claim, determines coverage, and pays their portion according to your plan. You’ll receive an Explanation of Benefits (EOB) statement that details what was covered, what you owe, and what the insurance paid. If you visit an out-of-network provider, you may need to pay the dentist directly and file a claim form yourself for reimbursement.
What are annual maximums in dental insurance?
The annual maximum is the highest total dollar amount your dental plan will pay toward your treatment in a plan year. Once you reach this limit, you are responsible for any additional dental costs. Maximums often range from $1,000 to $2,000 per year.
How often can I get my teeth cleaned?
Most dental insurance plans cover two cleanings (prophylaxis) per year, usually spaced six months apart. Some plans may offer more or fewer cleanings, so confirm with your insurer.
Is there a waiting period for coverage?
Many dental insurance plans have waiting periods before coverage begins for basic or major services (often from 3 to 12 months). Preventive care may be covered immediately. Check your policy to confirm waiting periods for each type of service.
How do I find a dentist in my plan’s network?
You can check your insurance company’s website or call their member services line for a list of in-network dentists. Many insurers offer a search tool to help you find local providers who accept your specific plan.
Are orthodontics or cosmetic dentistry covered?
Most standard dental insurance plans do not include cosmetic dentistry (such as whitening or veneers). Orthodontic coverage (for braces or aligners) is also limited and generally offered only in certain plans or as a special add-on, often for children. Always review your plan’s specifics to see if orthodontics or cosmetic procedures are included or require additional premiums.
What is the difference between preventative, basic, and major dental services?
Preventive Services: Routine care to prevent dental disease, such as cleanings, oral exams, x-rays, and fluoride treatments.
Basic Services: Treatments for common dental issues, including fillings, simple tooth extractions, and some periodontal work.
Major Services: More complex procedures like crowns, bridges, dentures, root canals, and surgical extractions.
What does dental insurance cover?
Dental insurance typically covers a range of preventive, basic, and major dental services. Preventive care (like exams and cleanings) often receives the highest coverage, while basic and major services are covered at lower percentages. Coverage levels and included procedures can vary by plan, so review your policy details for specifics.
Do I need a medical exam to get life insurance?
It depends on the policy and the coverage amount. Many traditional policies require a medical exam, but some policies—often for lower coverage amounts, or accelerated underwriting types—do not. These are sometimes called “no-exam” or “simplified issue” policies.
What is a cash value in life insurance?
Cash value is a savings-like component of some permanent life insurance policies (like whole life). It builds over time, and you can borrow against it or, in some cases, withdraw funds during your lifetime. Note: using cash value may reduce your death benefit.
Can I convert my term policy to a permanent policy?
Many term policies offer a conversion option, letting you switch to a permanent (whole or universal) policy without a new medical exam. Check your policy details or ask your provider about conversion options and windows.
What happens if I miss a payment?
Missing a payment often triggers a grace period (typically 30–31 days) during which you can pay to keep coverage in force. If you do not pay within that period, the policy may lapse and your coverage ends.
How are life insurance premiums determined?
Premiums are based on your age, health, lifestyle, coverage amount, policy type, and whether you use tobacco or engage in risky activities. Younger and healthier applicants generally pay less.
Who can be my beneficiary?
You can name anyone as your beneficiary—family, friends, a trust, or even a charity. You may designate more than one beneficiary and specify what portion each receives.
How much life insurance coverage do I need?
The amount depends on your financial responsibilities, such as debts, mortgage, dependents’ needs, and income replacement. Many people use a multiple of their annual salary (like 5–10 times) or a detailed needs analysis to determine coverage.
What is the difference between term and whole life insurance?
Term life insurance provides coverage for a set period (like 10, 20, or 30 years). If you die during the term, your beneficiary receives the payout. After the term, coverage ends (unless you renew or convert the policy).
Whole life insurance is a type of permanent insurance that covers you for your entire life as long as premiums are paid. It also builds up cash value that you can use during your lifetime.
What is life insurance and how does it work?
Life insurance is a contract between you and an insurance company that provides a tax-free payment (called a “death benefit”) to your chosen beneficiaries if you pass away while the policy is active. In return, you pay regular premiums. The purpose is to help protect your loved ones financially in your absence.
What is an out-of-pocket maximum?
This is the most you’ll spend for covered healthcare in a policy year. Once you reach this limit (by paying deductibles, copays, and coinsurance), your insurance pays 100% of covered costs for the rest of the year.
What happens if I miss a premium payment?
Missing a payment may trigger a grace period (typically 30 days), allowing you to pay without losing coverage. If you don't pay by the end of this period, your policy may be canceled, and you could have a gap in coverage.
How do I file a claim?
In most cases, your provider will file claims directly with your insurer. If required, you can file a claim by submitting a claim form and receipts to your insurance company, following their instructions.
What is an HMO vs. PPO?
HMO (Health Maintenance Organization): Requires you to choose a primary care doctor, get referrals for specialists, and use network providers except in emergencies. Often has lower premiums but less flexibility.
PPO (Preferred Provider Organization): Lets you see any doctor without a referral, including out-of-network providers (at higher cost). PPOs offer more flexibility but usually cost more.
Can I keep my doctor with this plan?
It depends on the plan’s network. Check if your preferred doctor or hospital is “in-network” for your specific plan. Some plans require you to use network providers for non-emergency care to get the lowest costs.
Are pre-existing conditions covered?
Yes, under current U.S. law, all Marketplace and employer plans must cover pre-existing conditions, and you cannot be denied coverage or charged more because of your health history.
What does my health insurance policy cover?
Most plans cover essential health benefits, such as preventive care, hospital stays, doctor visits, emergency services, prescription drugs, labs, and maternity care. Review your policy details to see exactly what is included and whether any services have limitations or require referrals.
How do I choose the right health insurance plan?
Compare plans based on your health needs, doctor or hospital preferences, prescription coverage, monthly premiums, out-of-pocket costs, and provider networks. Consider what’s most important—like keeping your doctor or minimizing surprise bills—and use comparison tools or speak with a licensed agent for guidance.
What is a premium, deductible, copayment, and coinsurance?
Premium: The monthly payment you make to keep your health insurance active, regardless of whether you use services.
Deductible: The amount you pay out-of-pocket for covered healthcare services before your insurance starts sharing costs.
Copayment (copay): A fixed amount (e.g., $25) you pay for certain services like doctor visits or prescriptions.
Coinsurance: Your share of the costs for a service, usually a percentage (e.g., 20%), after you meet your deductible.
What is health insurance and why do I need it?
Health insurance is a contract that helps pay for your medical and healthcare expenses. It protects you from high or unexpected medical costs and provides access to preventive services, helping you manage health needs while limiting your out-of-pocket spending. It’s often required by law and gives you peace of mind in case of illness or injury.
How do I cancel my insurance policy?
To cancel your policy, contact your insurance provider directly. They may ask you to submit a written request or complete a cancellation form. Be aware of any notice periods, policy terms, or potential cancellation fees. It’s wise to confirm with your provider that the policy is officially canceled and request written confirmation for your records.
Can I have more than one insurance policy?
Yes, you can have multiple insurance policies. For example, you can carry both health and life insurance, or have separate homeowners and flood insurance. Just ensure that overlapping policies do not violate any insurer’s rules—sometimes, “double coverage” won’t result in double benefits.
Are my dependents covered under my plan?
Whether dependents (spouse, children) are covered depends on your specific policy. Many health and life insurance plans offer dependent coverage, but you must list them when you enroll. Review your policy documents or contact your insurer to confirm who is included.
How do I change or update my policy?
To change or update your policy (such as adding coverage, updating beneficiaries, or changing contact information), contact your insurance provider’s customer service. They can guide you through submitting a request and update your policy documents as needed.
What happens if my claim is denied?
If your claim is denied, the insurance company will notify you and provide a reason. You can:
Request clarification and review the denial letter
Provide additional information that may support your claim
Appeal the decision according to the insurer’s appeals process
How does the claims process work?
If you need to file a claim:
Notify your insurance provider as soon as possible after an incident.
Provide all necessary details and documentation (such as police reports, receipts, or photos).
The insurer reviews your claim and may request additional information or send an adjuster to assess damages.
Once the claim is approved, payment will be made according to your policy terms.
What factors influence my insurance premiums?
Several factors can affect how much you pay for insurance, including:
Your age, location, and personal circumstances
Type and amount of coverage selected
Claims history or previous insurance record
Credit history (for some policies)
The value and risk profile of what is being insured (home, car, health, etc.)
What is an insurance premium?
An insurance premium is the amount of money you pay—monthly, quarterly, or annually—to keep your insurance policy active. It is the cost of maintaining coverage, regardless of whether you make a claim.