FAQ

We work with 20 top-rated insurance carriers so that our clients have access to all health plan options. We offer ACA health plans, indemnity health plans, PPO health plans, major medical health plans, medically underwritten health plans, short term medical plans, group health plans, small business health plans, self-employed health plans and association health plans.

With most health plans in the private insurance market, you can enroll at any time of year… not only when you have a qualifying life event. All individual health plans are month-to-month, with no annual contract period.

Many people change plans mid-year to save money, improve their health plan benefits, reduce their annual deductible or improve their plan network of providers.

Our experienced agents can help you to quickly and easily locate the best health plan based on your specific needs.

We can help to insure that the health plan you select meets these guidelines:

• The health plan allows you to choose your doctors and hospitals
• The monthly premium is within your budget
• The plan has benefits for checkups, doctor office and urgent care center visits, lab work, scans, hospital stays and surgeries, prescription drugs, ambulance services, major illnesses like cancer, and major accidents
• The health plan deductible is in a range that is comfortable for you
• The copays for medical services are in a range that works for you
• The insurance company highly-rated and financially secure

No. Our professional services at DFW Direct Insurance are 100% free. We can save you time and money by shopping the entire private health insurance marketplace for you. We have a meet or beat rate guarantee, so you rest assured that you will always get the lowest available monthly premium.

Independent health insurance agents represent multiple insurance carriers and have access to dozens of health insurance plans that are not advertised on any public websites. An experienced independent health insurance agent can help you to quickly locate the best health plan with all the benefits you need, without paying for benefits that you would never use.

Yes! After a quick 5-minute needs assessment call, we can search over 200 health plans from multiple top-rated carriers to create a custom health plan for you.

Most enrollments can be completed over a quick 5- to 10-minute phone call, and coverage can start as soon as the next day with many health plans.

Most health plans require a licensed agent to enroll individuals and families in health plans. The agent protects the consumer from making common mistakes on the application. There is no cost for an experienced agent at DFW Direct Insurance to assist in enrolling you in a quality health plan

Some insurance companies give a discount for enrolling multiple family members on the same health plan. Individual and family health plans have the same overall benefits.

Yes. The process of adding or removing family members is much easier in the individual health plan market than in the employer group market, since there are no open enrollment periods with most plans. As your needs change, you can add newborn children to you health plan, remove older children that are getting employer coverage, remove a spouse that is turning 65 are going onto Medicare, etc.

Monthly health insurance premiums can vary based upon a person’s age, gender, home zip code and tobacco use. Healthier people can join a medically underwritten health plan to save money without compromising benefits. These plans are not advertised on www.healthcare.gov. Monthly premiums start at $77 per month for individuals and $219 per month for families. Our experienced agents at DFW Direct Insurance can help you to shop for the best health plan at the lowest possible monthly cost.

Most health plans have an annual deductible that a person must first pay before the insurance company starts covering most or all of the medical expenses. For healthy people who rarely need medical care, a higher deductible plan can provide a lower monthly premium. For individuals requiring more frequent medical care, a lower deductible plan at a higher monthly cost can reduce out-of-pocket deductible expenses.

The out-of-pocket maximum is most a person will pay before their health insurance plan covers 100% of remaining medical expenses in a plan year or calendar year. To satisfy the out-of-pocket maximum, most health plans require a person to pay their annual deducible, plus any remaining coinsurance.

Example: John has a health plan with a $3,000 annual deductible, and 80% coverage after the deductible. The max out-of-pocket on his plan is $4,000. If John has a surgery, he can expect to pay his $3,000 deductible. Then his health plan starts paying 80% of his medical expenses. So John is still paying 20% of the medical bills (called coinsurance). Once John’s 20% in coinsurance expense adds up to $1,000, he has met the out-of-pocket max, and all medical expenses are then covered at 100% by the insurance company for the remainder of the calendar year.

Yes, all health plans in the private, or individual insurance market are month-to-month, with no cancellation fees.

ACA (Affordable Care Act) health insurance refers to major medical plans that meet federal coverage requirements and include protections for pre-existing conditions, preventive care benefits, and standardized coverage categories.

Generally, U.S. residents who are not incarcerated and are not eligible for certain other qualifying coverage may enroll. Eligibility rules and subsidy qualifications vary.

Premium tax credits help reduce monthly health insurance costs for eligible individuals and families. Eligibility is generally based on estimated household size and income and other factors.

Subsidy eligibility depends on household size, location, and annual household income. Eligibility thresholds change over time, so current estimates should be reviewed during enrollment.

If your income changes, update your marketplace information promptly. Changes may affect your subsidy amount and could impact taxes at year-end.

Yes. Self-employed individuals may qualify for premium tax credits if they meet income and eligibility requirements.

Open Enrollment is the annual period when most people can enroll in or change health insurance coverage. In most states, open enrollment is in the months of November and December.

Qualifying life events may include losing existing coverage, marriage, divorce, birth or adoption of a child, moving to a new service area, or other eligibility changes. People with a qualifying life event may enroll in an ACA plan at any time of year.

Possibly. Each health insurance plan has its own provider network. Before enrolling, it’s important to verify that your preferred doctors, specialists, hospitals, and facilities participate in the plan’s network. PPO network health plans pay benefits to any provider. HMO and EPO network plan do not pay benefits to out-of-network providers, with the exception of certain medical emergencies. Provider participation can change over time, so always confirm directly before receiving care.

Most ACA-compliant plans include prescription drug coverage, but covered medications and costs vary by plan. Insurance companies organize medications into formularies (drug lists) with different cost levels. Review your prescriptions before enrolling.

Many people first become eligible at age 65, although eligibility rules can vary. Enrollment timing matters because delayed enrollment may result in penalties depending on circumstances and coverage status. Most people should enroll in the three month period before turning 65. People who work past age 65 can enroll in Medicare Part B later when they eventually retire without a late enrollment period, so long as they have maintained continual coverage under a qualified employer health plan.

Medicare Advantage plans generally combine healthcare benefits into one managed plan and may include additional services. Medicare Supplement plans work alongside Original Medicare and help reduce certain out-of-pocket expenses. The right option depends on provider preferences, budget, and coverage goals.

Medicare Part D helps cover prescription medications. Covered drugs, formularies, pharmacy networks, and cost-sharing vary by plan. All part D plans have a $2,000 maximum out-of-pocket limit.

Yes. Medicare Advantage plan members can change plans during specific open enrollment periods. People with a Medicare supplement can change to a different Medicare supplement at any time of year, but in most cases will be subject to medical underwriting.

Outpatient prescription medications are not covered by original government Medicare.  Coverage is available through Medicare Part D or through certain Medicare Advantage plans that include drug coverage.

Original government Medicare works at all doctors and facilities that accept Medicare. Medicare supplements also work anywhere that government Medicare is accepted. Medicare Advantage plans all have specific networks of providers, so it is best to check with your healthcare providers to make sure they accept your specific Medicare Advantage plan.

Small business health insurance allows employers to offer medical coverage to eligible employees. Employers typically select available plan options and decide how much of the premium to contribute, while employees enroll in the coverage offered.

In many cases, small group plans are available for businesses that meet minimum of five participating employees. There are now several options available without any minimum number of participating employees! Call DFW Direct Insurance at 817-449-5557 for more details.

Some health plans require the employer to cover 50% of the monthly plan premium. Others do not have any contributions requirements… so the employer can pay part, all or none of the employee health plan premium. Call DFW Direct Insurance at 817-449-5557 for more details.

Employer-sponsored health insurance may provide tax benefits for eligible businesses and employees. Tax treatment varies, so businesses should consult qualified tax professionals for guidance.

Depending on the coverage arrangement, employees may be able to choose among multiple plan options offered by the employer.

A premium is the amount paid to maintain health insurance coverage, usually monthly. Paying premiums does not eliminate deductibles, copays, or other cost-sharing requirements.

A deductible is the amount you generally pay for covered healthcare services before certain insurance benefits begin according to your plan terms.

Example: If your deductible is $2,000, you may pay eligible expenses up to that amount before cost-sharing changes.

Coinsurance is your share of covered healthcare costs after meeting your deductible.

Example: If your plan pays 80% and your coinsurance is 20%, you would pay 20% of eligible covered expenses.

A copay is a fixed amount you pay for certain services, such as doctor visits, prescriptions, or urgent care visits. Copay amounts vary by plan, and are generally not subject to the health plan deductible.

In-network providers have agreements with the insurance company that may lower your costs. Out-of-network providers may result in higher expenses or reduced coverage depending on your plan. PPO health plans offer the most freedom to use any in- or out-of-network doctor or facility.

Health plan pre-authorization (also called prior authorization or precertification) is a process where your doctor must get approval from your health insurance provider before covering a specific medical service, procedure, or prescription. It serves as a check to ensure the proposed treatment is medically necessary, safe, and cost-effective. Many health plans are now available that do not require any pre-authorization. For information on these plans, please call DFW Direct Insurance at 817-449-5557.

Medical underwriting is the process insurance companies use to evaluate your health history and lifestyle to assess risk. Based on this assessment, the insurer decides whether to approve your application, how much your premiums will cost, and whether to apply any coverage exclusions or limitations. Medically underwritten health plans generally feature lower monthly premiums, since the insurance company can better manage the risk of insuring individuals and families.