🧠 Important Questions to Ask When Shopping for a Health Plan
Before enrolling in any plan — especially one that’s not ACA-compliant — it’s critical to ask the right questions to make sure you’re not signing up for something that only looks like insurance.
Here are four key questions you should always ask:
1. What is my out-of-pocket maximum?
This is the most you’ll ever have to pay in a calendar year for covered services.
➡️ The answer should be a specific dollar amount, such as $3,000 or $5,000 — not a vague “it depends” or “you’ll just pay what the discount is.”
If they can’t give you a number, it’s likely not real insurance.
2. What is the policy maximum (aka benefit cap)?
This is the total amount the plan will pay out over the life of the policy.
➡️ A legitimate plan should have no cap. If the plan limits benefits to $100,000 or $250,000 — that’s a red flag. It means the plan is limited-benefit, and you could easily max it out with one hospital visit.
3. Is this plan fully comprehensive?
Don’t settle for a long explanation. The answer should be simple and confident.
➡️ Look for a clear “Yes.”
If they hesitate, deflect, or start listing what isn’t covered, the plan likely has serious holes.
4. What is your National Producer Number (NPN)?
Every licensed insurance agent in the U.S. has one.
➡️ If someone is selling you health coverage, they should be willing to provide their NPN without hesitation. This is your way of confirming you’re speaking to a licensed professional — not a call center rep pushing junk policies.
Asking these questions can save you from thousands of dollars in unexpected bills — and help you separate legitimate private plans from glorified discount cards or short-term traps.
If you're not sure how your current plan stacks up, reach out and let us review it with you. It only takes a few minutes, and it could be the difference between feeling secure and being blindsided.
⚠️ Why Limited-Benefit and Short-Term Medical Plans Can Leave You Exposed
If you're shopping for health insurance, it's easy to get lured in by low monthly prices or quick approvals — especially with so many options available online. But not all health plans are created equal. Some, like short-term medical (STM) and limited-benefit plans, may appear affordable upfront but offer very little real protection when you need it most.
🚫 What Are These Plans — and What’s the Catch?
Short-Term Medical (STM) plans are temporary policies that offer basic coverage for a limited time (a few months up to a year).
Limited-Benefit Plans pay fixed dollar amounts for specific services — like $100 for a doctor’s visit or $2,000 for a surgery — no matter what the actual bill is.
These plans can leave you holding the bag financially if you end up in the hospital or need ongoing care. Many people don’t realize the gaps until it’s too late.
🛑 5 Reasons to Be Cautious
1. Gaps in Critical Coverage
These plans typically don’t include essential benefits like:
Ongoing outpatient care
Preventive services
Prescription drugs
Mental health treatment
Pre-existing condition coverage
2. No Real Financial Protection
Limited-benefit and STM plans often lack caps on out-of-pocket costs. If you're hit with a serious illness or injury, you could face massive bills with no coverage safety net.
3. Misleading Appearances
They may look like full coverage, but that’s often due to confusing or overly vague marketing. Some agents even refer to them as “health insurance” — when they’re technically not.
4. Temporary, Unreliable
Short-term plans aren’t built to stick around. They expire quickly, often aren’t renewable, and can deny future coverage for new conditions.
5. Can Interfere with Long-Term Insurance Goals
Some people mistakenly think these plans will “hold them over” — but using them too long can leave you uninsured or ineligible for better options later on.
✅ There ARE Great Non-ACA Plans — If You Know Where to Look
Not all private plans are bad. In fact, there are excellent non-ACA, health-based plans available that offer:
Comprehensive coverage for doctor visits, hospitalizations, surgeries, and prescriptions
Nationwide PPO networks
Low deductibles and out-of-pocket maximums
Real financial protection in case of serious illness or injury
These plans are not the same as STM or limited-benefit policies. They’re built to last, and they’re built to work — especially for individuals and families who are generally healthy and don’t qualify for major ACA subsidies.
💡 Don’t Confuse Affordable with Inadequate
Low-cost options aren’t bad — as long as they’re actually protecting you. If a plan’s benefits are capped, temporary, or full of exclusions, it may not be worth the risk.
Before you choose a policy, ask:
Does this cover real-world medical expenses?
Is there a cap on what I might have to pay out of pocket?
Will this protect me if I’m hospitalized or diagnosed with something serious?
👋 Let’s Talk Real Coverage
If you’re exploring private health insurance options and want true peace of mind without breaking the bank, we can help. Our plans are full-featured, reliable alternatives — not the “too good to be true” kind.
Let’s walk through your options and find something that fits your needs, your health, and your budget — without the nasty surprises.
Health Share Horror… BEWARE!
5 Issues with Health Share Plans You Must Know Before Enrolling
Health share plans, also known as healthcare-sharing ministries, are an alternative to traditional health insurance. These plans involve a group of individuals who share medical costs amongst themselves. While these plans may seem appealing due to their lower cost and potential for customization, there are several issues with health share plans that consumers should be aware of before enrolling.
Not Regulated: by the Government Unlike traditional health insurance, health share plans are not regulated by the government. This means that there are no guarantees of coverage, and the plans are not required to meet any minimum standards for benefits or financial stability. This lack of regulation can lead to confusion and uncertainty for consumers, as well as potential financial risk if the plan is unable to cover unexpected medical expenses.
Limited Coverage: Health share plans may have limited coverage for certain medical services, such as preventive care, mental health, and pre-existing conditions. Some plans may also have restrictions on certain procedures or treatments, which could result in higher out-of-pocket costs for the consumer. Additionally, there may be caps on the total amount of medical expenses that the plan will cover, which could leave consumers responsible for a significant portion of their medical bills.
Eligibility Requirements: Health share plans often have eligibility requirements that may exclude certain individuals. For example, some plans may require members to adhere to a certain set of religious beliefs, or to abstain from certain behaviors such as smoking or drinking alcohol. These requirements may limit the number of people who are able to enroll in the plan and may not be inclusive of all individuals.
No Guarantee of Payment: Health share plans operate on a voluntary basis, meaning that there is no guarantee that other members will contribute to the costs of your medical expenses. While most plans have a track record of making payments on eligible medical expenses, there is no legal obligation to do so. This lack of guarantee can leave consumers vulnerable to unexpected medical bills and financial strain.
Limited Consumer: Protection Health share plans are not subject to the same consumer protection laws as traditional health insurance plans. For example, health share plans may not be required to provide a written explanation of benefits or adhere to timely payment requirements. Additionally, there may be limited recourse for consumers who feel that their claims have been improperly denied or delayed.
In conclusion, while health share plans may appear to offer an alternative to traditional health insurance, there are several issues that consumers should consider before enrolling. These plans are not regulated by the government, have limited coverage and eligibility requirements, and may not offer the same consumer protections as traditional health insurance. As with any healthcare decision, it is important to carefully evaluate the pros and cons of health share plans and consult with a trusted healthcare professional before making a decision.
Health Insurance Vocabulary!
NEED TO KNOW health insurance terms.
Health insurance is a complex and often confusing topic for many people. Understanding the vocabulary of health insurance is crucial to making important decisions about your coverage. In this blog post, we will explain some of the most common health insurance vocabulary words.
Deductible: A deductible is the amount of money you pay out of pocket before your insurance kicks in. (For example, if you have a $1,000 deductible, you would need to pay the first $1,000 of your medical expenses before your insurance begins to cover costs.)
Copayment: A copayment, or copay, is a fixed amount you pay as an entry fee for a specific medical service or prescription. (For example, if your copay for a doctor’s visit is $20, you would pay $20 at the time of the appointment.)
Coinsurance: Coinsurance is the percentage of medical expenses you are responsible for paying after you have met your deductible. (For example, if you have a 20% coinsurance, you would be responsible for paying 20% of the total cost of your medical expenses, and your insurance would cover the remaining 80%.)
Premium: A premium is the amount you pay each month for your health insurance coverage.
Out-of-pocket maximum: The out-of-pocket maximum is the maximum amount of money you will have to pay for covered medical expenses in a given year. Once you reach this amount, your insurance will cover all remaining costs.
Network: A network is a group of healthcare providers and facilities that have contracted with an insurance company to provide services to their members. In-network providers typically offer lower costs to insured individuals.
Provider: A provider is a healthcare professional or facility that provides medical services. This can include doctors, hospitals, clinics, and pharmacies.
Pre-existing condition: A pre-existing condition is a health condition that existed before you enrolled in your current health insurance plan. In the past, insurance companies could deny coverage or charge higher premiums to people with pre-existing conditions, but this is no longer allowed under the Affordable Care Act.
HMO, PPO, and EPO: These are types of health insurance plans that differ in terms of the flexibility they offer. HMOs, or health maintenance organizations, require you to choose a primary care physician and typically only cover care within their network. PPOs, or preferred provider organizations, allow you to see out-of-network providers but often at a higher cost. EPOs, or exclusive provider organizations, are similar to HMOs but may offer some out-of-network coverage in certain circumstances.
Understanding these health insurance vocabulary words can help you make more informed decisions about your healthcare coverage. When shopping for health insurance or discussing coverage with your provider, be sure to ask questions and clarify any terms you don't understand.