Q&A Series: Image Descriptions, Transcript, and Links

Q&A Series: 01: Agents vs. Brokers

DATE: 01-20-2025

Detailed image description:

The image is a colorful infographic divided into sections.

At the top, there is a bold header "Q & A" placed on a colorful abstract background with swirling patterns in red, blue, and orange.

Below this header, a white section contains text discussing the differences between an agent and a broker regarding health insurance. The section has a large "Q" and "A" to denote question and answer, using black text on a red background for emphasis.

The bottom banner of the image is bright orange with bold black and magenta text, displaying contact information and branding with the words "JENSURANCE!" alongside "Let's find your insurance solution." Contact information includes an email, website, and phone number.

Text transcript:

Q: What’s an agent? What’s a broker? What’s the difference? When would I want to use one anyway?

A: A trained professional who can help you enroll in a health insurance plan.

Agents may work for a single health insurance company; brokers may represent several companies. You won't pay anything additional if you enroll with an agent or broker.
Agent and broker (health insurance) - Glossary | HealthCare.gov

The answers to this vary with the source and even the state you live in. I say they’re essentially the same thing but agents sometimes work for an agency. (So can brokers.) Let’s hear from the Centers for Medicare & Medicaid Services about the important part: what do they do and why would you want to use one?

Licensed agents/brokers play a key role in the Health Insurance Marketplace® by providing consumers with expert guidance on plan options in their area while assisting with everything from comparing costs and coverage to applying for financial assistance. By working with individuals one on one, they help millions each year find and enroll in the best coverage for their specific needs.

Shopping for insurance can be confusing. People often need help understanding different metal levels, copays, deductibles, and subsidy eligibility. They also need accurate, localized information on provider networks, and differences between plans. Agents/brokers, who often live & work in the communities they serve, bring personalized guidance by sharing detailed knowledge of networks in a consumer’s local area.
SOURCE: CMS.gov Agents and Brokers in the Marketplace

Q&A Series: 02: What’s the APTC?

DATE: 01-21-2025

Detailed image description:

The image is a Q & A informational graphic with a vibrant and colorful abstract background in the top portion, featuring swirling patterns in blue, red, and orange.

In the foreground, the text addresses questions about the Advance Premium Tax Credit (APTC) under the Affordable Care Act. The top left corner has "Q & A" written in bold pink letters with a black outline.

Below, the text in black reads: "What’s the APTC and how does it work?" This is followed by a detailed explanation, emphasizing the role of APTCs in reducing health insurance costs by acting as an advance on premium tax credits.
The bottom of the image has a vivid pink and black banner promoting "JENSURANCE!" with additional contact information.

Text transcript:

Q: What’s the APTC and how does it work?

A: Thanks to the Affordable Care Act (ACA aka Obamacare) of 2010, PTCs (premium tax credits) were introduced as just one form of savings eligible consumers can receive to make health insurance more affordable.

APTCs are an advance on the premium tax credit that consumers can use to lower their monthly insurance payments (premiums) when they enroll in a plan through the insurance Marketplace.

The APTC is based on the estimated annual household income and the household size that the consumer reports on their Marketplace application. Their PTC is calculated after the end of the year based on actual household income and size for the year at tax filing. Depending on how the actual annual income differs from the estimate, they may be required to repay excess APTC received when filing their federal income tax return, or they might end up getting money back.

I didn't even understand this until I had already gotten my license. So I ask you: does this make sense? If not, I'll do it again and word it differently. I need to know how to explain it to make sense to people so input is very much appreciated! (Considering a full blog post on this to go into more detail because it’s one of the most commonly misunderstood concepts about the entire ACA Marketplace.)

SOURCE: APTC and CSR Basics | CMS

Q&A Series: 03: Choosing an Agent/Co.

DATE: 01-22-2025

Detailed image description:

The image is a vibrant informational graphic titled "Q & A" at the top center, with a multicolored abstract background at the top.
The main section contains a question and answer format. The question reads, “How do I choose an insurance agent or company?” The response advises consulting the Texas Department of Insurance and provides several recommendations.

Below, it lists notable points like asking friends and family, checking online reviews, and ensuring the company is licensed by the TDI. There's a phone number "800-252-3439" for inquiries. A red triangular caution symbol with an exclamation mark warns about red flags such as unsolicited calls, unusually low insurance prices, and cash-only payment demands. There's a reminder about a follow-up Q&A session scheduled for the next day.

The bottom section has a branded area with “JENSURANCE!” in bold text, contact information including an email and website, and the phone number "832.458.1455" over a blue, red, and orange abstract design.

Text transcript:

Q: How do I choose an insurance agent or company?

A: When looking for an agent/company, the Texas Department of Insurance (TDI) recommends the following:

• Ask friends and family if they have a company or agent they like.
• Check online consumer reviews to make sure a company pays claims on time and provides good service.
• Make sure the agent or company is licensed by TDI

SOURCE: Look up an insurance company or find a company’s agent for service of process

Call the TDI Help Line at 800-252-3439 to find out:

• If a company or agent is licensed by TDI.
• How many complaints have been filed against a company or agent.
• If TDI has taken any disciplinary actions against them.

Look out for these red flags:

• Someone calling you unsolicited or using high-pressure sales tactics.
• Prices for insurance that are MUCH LOWER than you’ve seen elsewhere.
• Anyone telling you to pay in cash or to sign a contract with blanks.

How do I find an insurance agent or company?

FOLLOW UP Q&A TOMORROW 01/23: Verifying credentials! “Where can I look up an insurance agent/company to see if they’re legit?”

Q&A Series: 04: Verifying Agent Credentials

DATE: 01-23-2025

Detailed image description:

The image is an informational graphic that addresses how to verify an agent or broker's credentials. The top section is labeled "Q & A" in large, bold text against a vibrant, abstract background consisting of colorful swirls.

Below this, a clearly defined text box contains a question and answer format. The question is printed in black, bold letters: "Where/how can I verify an agent/broker’s credentials by their NPN or license number?" The answer explains the process using the National Insurance Producer Registry (NIPR) and the Producer Database (PDB). It also describes the role of the PDB and lists what it provides, such as demographic information, license and appointment information, and regulatory actions. A small icon of a document with a checkmark appears on the right side of this section.

At the bottom, a black and red banner features the company’s branding: "JENSURANCE!" followed by the slogan "Let's find your insurance solution!" Contact details, including an email, website, and phone number, appear beneath this banner.

Text transcript:

Q: Where/how can I verify an agent/broker’s credentials by their NPN or license number?

A: You can look up an agent/broker by their NPN (National Producer Number) or license number using the National Insurance Producer Registry (NIPR).

National Insurance Producer Registry

You can also use the Producer Database (PDB) to check an agent’s licensing records.
The PDB is a central repository of producer licensing information updated on a timely basis by participating state insurance departments. The PDB includes data from external databases such as the Regulatory Information Retrieval System (RIRS) to provide a more comprehensive producer profile.

Producer Database (PDB) | NIPR

The PDB provides:

• General demographic information
• License and appointment information
• Information about regulatory actions

NPN Validation FAQ from Centers for Medicare & Medicaid Services (CMS): National Producer Number (NPN) Validation Frequently Asked Questions (FAQs)

Q&A Series: 05: What are subsidies?

DATE: 01-24-2025

Detailed image description:

The image features a Q&A format graphic about health insurance subsidies. The top section has a colorful, abstract background with the letters "Q & A" prominently in the center.

Below, a question is posed in a rectangular box on the left: "What is a health insurance 'subsidy'? Who is eligible for one?" The answer is provided on the right, detailing that subsidies offer reduced or no-cost insurance for those within certain income ranges, with examples including Medicaid and CHIP.

Eligibility is based on household size and income. Criteria for 2025 include income at least equal to the federal poverty level, lack of affordable employer plans, and other conditions. A small icon depicts a document and a person holding it.

The bottom section promotes "Jensurance!" with contact information and a website.

Text transcript:

Q: What is a health insurance “subsidy”? Who is eligible for one?

A: It is simply health insurance available at reduced or sometimes no cost for people whose household income is within a certain range.

Examples: Medicaid or CHIP (Children’s Health Insurance Program). Marketplace insurance plans with premium tax credits (PTC) are known as subsidized coverage, too.

Subsidized coverage - Glossary | HealthCare.gov

Eligibility for subsidies is determined by household size and income.

To qualify for a Marketplace subsidy in 2025, you must meet the following criteria:

• Household income at least equal to the federal poverty level (FPL)
• Not have access to an affordable employer plan
• Not be eligible for coverage through Medicaid, Medicare, or CHIP
• Be a U.S. citizen or lawfully present immigrant
• If married, file taxes jointly

The FPL for 2025 is $15,060 for a single adult and $31,200 for a family of four.

NEXT UP TOMORROW 01/25: “What are the 2 types of Marketplace subsidies & how do they help?”

Explaining Health Care Reform: Questions About Health Insurance Subsidies | KFF

Q&A Series: 06: Types of Subsidies

DATE: 01-25-2025

Detailed image description:

The image is a vibrant informational graphic detailing Marketplace subsidies. At the top, a section labeled "Q & A" in large, bold letters.

Below this, a question is posed: "What are the 2 types of Marketplace subsidies? How do they help?" The answer follows, stating the two types: PTC (Premium Tax Credit) and CSR (Cost Sharing Reductions), and explaining how they assist with insurance costs.

PTCs reduce monthly premium payments, while CSRs reduce deductibles and out-of-pocket costs for medical visits. There is a note on eligibility requirements for these subsidies. The graphic includes links to additional resources, with one link presented next to the subsidy types and another at the bottom for further information.

Additional promotional content at the bottom advertises "Jensurance," with contact details and a colorful background featuring abstract swirls in blue and red hues.

Text transcript:

Q: What are the 2 types of Marketplace subsidies? How do they help?

A: Two types of Marketplace subsidies:

• PTC: Premium Tax Credit
• CSR: Cost Sharing Reductions

What help is available | HealthCare.gov

How the two types of subsidies help with insurance costs:

• PTCs help by reducing enrollees' monthly payments (premiums) for insurance coverage.
• CSRs help by reducing enrollees' deductibles and other out-of-pocket costs when they go to the doctor or have a hospital stay.

If qualified for either or both, individuals and families must enroll in a Marketplace plan.
PTCs can be applied to any "metal level" plan, but CSRs only apply if enrolled in a Silver metal level plan.

NEXT UP TOMORROW 01/26: "What are the metal levels? Which is best?"

Explaining Health Care Reform: Questions About Health Insurance Subsidies | KFF

Q&A Series: 07: What are “metal levels”?

DATE: 01-26-2025

Detailed image description:

The image is a colorful, informational advertisement about insurance, featuring a "Q & A" section with information on "metal levels" in insurance plans. The background has an abstract pattern with swirls and a mix of colors.

The section begins with a question, "What are 'metal levels'? Which one provides the best care?" followed by an answer that explains how metal levels represent the cost-splitting between insurance and the insured. It mentions that metal levels and plan types do not impact care quality, and it refers to the ACA’s requirements.

A table compares four metal categories: Platinum, Gold, Silver, and Bronze, illustrating their corresponding plan pay percentages, member pay percentages, and deductibles. Below the table, it states that percentage estimates vary, especially with "silver with savings", based on subsidy eligibility.

The header at the bottom reads "JENSURANCE!" alongside contact information, with a vibrant and bold color scheme.

Text transcript:

Q: What are “metal levels”? Which one provides the best care?

A: The metal levels represent how you & your insurance company split costs for covered services.

Each category may include several different types of plans and provider networks (HMO, PPO, etc.)

Health Plan Categories - Glossary | HealthCare.gov

Cost sharing reductions (CSRs), one of the subsidies, are only available if you enroll in a SILVER plan. Metal levels and plan types DON’T IMPACT QUALITY OF CARE. Thanks to the ACA, all plans offered in the Marketplace are required to meet certain standards to be certified as a qualifying health plan (QHP) and they must include the 10 EHBs (essential health benefits), which you can learn more about at Find out what Marketplace health insurance plans cover | HealthCare.gov

Percentages listed are estimates & will vary by plan. Percentages on “silver with savings” will vary based on the amount of CSR applied (determined by your eligibility).

Health plan categories: Bronze, Silver, Gold & Platinum | HealthCare.gov

TOMORROW: HMO, PPO, POS, EPO?

Q&A Series: 08: Plan/Network Types

DATE: 01-27-2025

Detailed image description:

The image is an informational graphic featuring a colorful, abstract background with vivid swirls and shapes in shades of orange, red, blue, and black. At the top, it reads "Q & A" in a bold font.

Below, a text box labeled “Q: What's the difference between plan types like HMO, PPO, etc? Which is best?” followed by “A:” provides detailed explanations of different health insurance plan types including HMO, PPO, EPO, and POS.

Each plan is briefly described with emphasis on network size and the necessity for specialist referrals. There are references to further details and an upcoming e-book.

At the bottom, a vibrant banner displays the brand name "JENSURANCE!" alongside a call to action and contact details in eye-catching colors.

Text transcript:

Q: What's the difference between plan types like HMO, PPO, etc? Which is best?

A: Different types of Marketplace plans are meant to meet different needs.

Some limit provider choices and charge more for care outside their network. Some require a referral from your Primary Care Provider (PCP) to see a specialist. What’s best depends on your specific needs.

• HMO: Smaller network - PCP referral for specialist
• PPO: Costs more than HMO - In-network care costs less - No referral for specialist
• EPO: Must see in-network providers - No referral for specialist
• POS: Costs less if you see in-network providers - PCP referral for specialist

For full details, view this excellent reference: What You Should Know About Provider Networks

Plan types and categories are also fully covered in my upcoming e-book, Obamacare? Marketplace? The Exchange?: A Comprehensive Guide!

Health insurance plan & network types: HMOs, PPOs, and more | HealthCare.gov

Q&A Series: 09: Losing Job-Based Coverage

DATE: 01-28-2025

Detailed image description:

The image is an informative graphic about health coverage options when job-based insurance is lost. The top portion features a multicolored abstract design background with the text "Q & A" prominently displayed in bold, pink letters with black outlines.

Below is a section labeled with a "Q" in a pink box, followed by the question: "I just lost my health coverage when I lost my job. Can the Marketplace help?" The answer "A" is also in a pink box, followed by detailed text providing guidance on health coverage options like the Marketplace, COBRA, and Medicaid. These options are explained under bold headings.

At the bottom is a colorful banner with the text "JENSURANCE! Let's find your insurance solution!" in large, bold letters. The contact information is listed on the right with an email, website, and phone number.

Text transcript:

Q: I just lost my health coverage when I lost my job. Can the Marketplace help?

A: Outside of Open Enrollment, you can apply for a SEP (special enrollment period) if you’re losing job-based coverage due to leaving a job (no matter WHY you’re leaving), or if your employer stops offering it.

Some options for coverage when you’ve just lost a job:

• Marketplace: You can buy a plan during open enrollment & special enrollment periods. To get a SEP, you must have lost coverage in the past 60 days or will lose it in the next 60 days. You may qualify for tax credits to help pay your premium.
• COBRA: If your coverage is ending because of losing your job, you can continue your plan for 18 months under the federal law, COBRA. If you’ve had COBRA and it’s running out in the next 60 days, you may qualify for a SEP.
• Medicaid: You can apply any time. If you’ve had Medicaid and lose it, you may qualify for a SEP.

There are many reasons that qualify for a SEP. If you want to see if you qualify, check HealthCare.gov, talk to your agent/broker, or call 800-318-2596. If you’re denied & still feel you qualify, you can appeal the decision.

Losing Health Coverage | HealthCare.gov

TOMORROW 01/29: “How do I find a new PCP?”

Q&A Series: 10: Finding a New PCP

DATE: 01-29-2025

Detailed image description:

The image is a Q&A informational graphic with various sections and vibrant colors. At the top, a swirling abstract design in blue, pink, and brown hues serves as the background. The large text "Q & A" is displayed prominently in bold, dark pink with a black outline.

Below, the main section contains text on tips for finding a new primary care provider and addressing long wait times. The text is primarily in black on a light tan background, accompanied by "Q" and "A" icons in white letters on a red background.

At the bottom, a colorful banner with the text "JENSURANCE!" features in white against a pink and black background. Contact information including an email, website, and phone number is aligned to the right in yellow and orange over a black and orange background.

Text transcript:

Q: How do I find a new Primary Care Provider? Why are there such long waits to get a first appointment?

A: For a list of in-network providers, log into your insurance online access and search by your location and type of provider needed.

Unfortunately, some insurance companies don’t update their listings as often as they should so you should always call and check that the provider still exists and is still in-network.

The long wait for appointments is because of a massive shortage of primary care doctors, due to retirement, burnout, & fewer medical students choosing this specialty.

TO GET AN APPOINTMENT SOONER:

• Keep an open mind to seeing someone other than the doctor. At many clinics, you can designate a doctor as your PCP if your insurance requires it, but see other providers in the office, such as nurse practitioners, physician assistants. They are supervised by the doctor & you can usually get in fast.
• Consider telehealth appointments. Lots of insurance plans cover these now and it’s a great way to get quick treatment for common illnesses like sinus infections, digestive issues, etc.
• Try unpopular appointment times, like the first available of the day. Sometimes they’re as early as 6:30 a.m. but you actually end up getting through quicker because nobody is running behind yet!

Nurse Practitioner Vs. Physician Assistant: What’s The Difference? | NurseJournal.org

TOMORROW: Turning 26 & losing parents’ coverage

Q&A Series: 11: Losing parents’ coverage when turning 26

DATE: 01-30-2025

Detailed image description:

The image is a multi-colored informational graphic with a swirling abstract design at the top in shades of red, blue, and green. Overlaying this design is a bold title "Q & A" in large, black letters with a red outline on the top left. Below the title, a question-and-answer section is presented. A boxed "Q" and "A" in black and red highlight marks the start of the question and answer.

The question reads: "I'm turning 26 and losing coverage from my parents' health plan. Can the Marketplace help?" The accompanying answer explains options for health insurance for those turning 26, such as employer plans, student health plans, and applying for a Marketplace plan. Its text is in black font against a cream background with certain phrases emphasized in bold black text to outline key actions.

At the bottom, a vibrant stripe with contrasting colors displays promotional content with the branding "JENSURANCE!" in pink and the text "LET'S FIND YOUR INSURANCE SOLUTION" outlined in white below it. Contact information is included.

Text transcript:

Q: I'm turning 26 and losing coverage from my parents' health plan. Can the Marketplace help?

A: Generally, if you're on a parent's Marketplace plan, you can remain covered until Dec. 31 of the year you turn 26 (or the age permitted in your state).

That’s during Open Enrollment so you'll have the option to apply for a Marketplace plan of your own. If someone is still claiming you as a tax dependent, you won’t be eligible for subsidies to help with costs.

• If you’re employed, you may be able to enroll in a plan through your job once you turn 26. Your birthday doesn’t have to fall inside of the usual enrollment period. Employers usually pay a portion of your premium or the amt. paid to an insurer for coverage.
• If you’re under 30 and enrolled in school, you may be eligible for a student health plan. Contact your school’s health services dept. to learn more about options.
• If you apply for a Marketplace plan, you’ll also find out if you qualify for Medicaid or CHIP. If you have limited income or are pregnant, you may qualify.

WHEN CHOOSING A PLAN: Be careful! Some products are not true health insurance and aren’t required to protect you in the same way. Discount plans, risk-sharing plans, and health care sharing ministries (HCSMs) are not insurance products and are not governed by consumer protection laws. See guidance for choosing a plan from HealthCare.gov at: If you’d like to change to a Marketplace plan | HealthCare.gov

What Should I Do When I Turn 26 and Need My Own Health Insurance?

TOMORROW: Does the Marketplace have dental?

Q&A Series: 12: Marketplace dental coverage

DATE: 01-31-2025

Detailed image description:

The image contains a digital infographic with a colorful abstract background at the top. It prominently features the text "Q & A".

Below, the main content discusses dental insurance in Marketplace plans. An initial large "Q" introduces the question about dental insurance coverage, followed by the text explaining the options for obtaining dental coverage through the Marketplace. The text details health plans with dental coverage and separate dental plans, outlining the conditions for each.

At the bottom left, there is contact information, including a website and email address. The lower strip of the image contains a bold title, "JENSURANCE!" with the slogan, "Let's find your insurance solution."

Text transcript:

Q: What about dental insurance? Do Marketplace plans cover dental?

A: Dental coverage is available TWO WAYS from the Marketplace: you can pick a health plan that comes with dental, or choose a health plan without dental and get a separate dental plan.

NOTE: You can’t buy a dental plan through the Marketplace unless you’re also buying a health plan at the same time.

Health plans with dental coverage: Some Marketplace health plans have dental coverage. You can see which ones do when you’re comparing plans. If the health plan includes dental, the premium covers BOTH health and dental coverage.

Separate dental plans: In some cases, separate dental plans are offered, and you can see them when shopping plans in the Marketplace.
If you get a separate dental plan, you’ll pay a separate premium (in addition to the one you pay for your health plan).

Answer some quick questions and you can preview health plans with dental & separate dental plans: Health insurance plans & prices | HealthCare.gov

See link below for adult/child dental info & details of high/low level plans:
Dental Coverage in the Health Insurance Marketplace® | HealthCare.gov

TOMORROW: What is balance billing?

Q&A Series: 13: What’s balance billing?

DATE: 02-01-2025

Detailed image description:

The image is an informational graphic with a vibrant, abstract background featuring swirling colors in blue, red, and orange. The main content area is a beige box containing text about "balance billing" with the title "Q & A" at the top, prominently displayed in large, bold pink letters.

Below, a question asks, "What is 'balance billing'? Why does everything say to avoid it?" followed by an answer in smaller, black text explaining the implications and avoidance of balance billing. A boxed "Q" and "A" in pink highlight the question and answer sections. Additionally, there's a list of scenarios under "TX laws ban balance billing for:"
with bullet points detailing situations affected by balance billing laws.

The bottom of the image features a colorful banner promoting "JENSURANCE!" with the tagline "Let's find your insurance solution!" in bold letters. Contact information including an email, website, and phone number is provided on the lower right.

Text transcript:

Q: What is "balance billing"? Why does everything say to avoid it?

A: Balance bills occur when a provider outside of your plan’s network charges more than your plan pays, so the provider bills you for the difference. You can avoid the cost of balance bills if you choose providers in your health plan’s network.

Using Your Health Plan

In-network providers have agreed to accept the plan’s payment as full payment and won’t send you a balance bill. In the event you MUST use an out-of-network provider/service, your state may have laws to protect you from balance billing. Contact your state insurance department for details.

TX laws ban balance billing for:

• Certain medical services/supplies provided on or after January 1, 2020.
• Emergency medical services (EMS) & trips provided by a ground ambulance on/after Jan. 1, 2024.
• This does not apply to air ambulance services.

Health plans have to pay an amt. set by TX law for EMS care and ground ambulance trips. Health plans and out-of-network providers/facilities must use the Independent Dispute Resolution (IDR) portal to mediate/arbitrate disputes WITHOUT involving the consumer.

For help w/surprise medical bills: How to get help with a surprise medical bill

Balance billing: Independent Dispute Resolution

TOMORROW: What’s a qualified health plan?

Q&A Series: 14: What’s a QHP?

DATE: 02-02-2025

Detailed image description:

The image is an informational graphic about Qualified Health Plans (QHP) in the marketplace. The top section features a colorful, abstract background with the title "Q & A" in bold black letters within a pink box.

Below, a white section contains a question in bold black text: "What exactly makes a certified 'qualified health plan' (QHP) in the Marketplace?" The answer provided explains that a QHP meets Affordable Care Act (ACA) and state requirements for certification to be sold in the Health Insurance Marketplace. Bullet points list requirements such as being licensed, covering pre-existing conditions, and covering essential health benefits (EHBs).

There's reference text linking to more information. At the bottom, a colorful banner promotes "JENSURANCE!" with contact details in vivid fonts.

Text transcript:

Q: What exactly makes a certified “qualified health plan” (QHP) in the Marketplace?

A: A QHP is a health plan that meets Affordable Care Act (ACA) and state requirements for the certification necessary to be sold in the Health Insurance Marketplace®. Certification occurs each year before the Open Enrollment Period.

What is a qualified health plan? | healthinsurance.org

Many QHPs are also available off-exchange, directly from the health insurance company, but you can only qualify for the ACA’s premium tax credits and/or cost sharing reductions if you buy through the Marketplace (Exchange).

Some QHP rules - certified QHPs MUST:

• Be licensed in the state where coverage is provided
• Cover pre-existing conditions
• Follow cost-sharing limits
• Cover the ACA ten essential health benefits (EHBs) with no $$ limits on annual or lifetime benefits

For full list of EHBs: What are essential health benefits? | healthinsurance.org

All plans sold in the Exchange/Marketplace, at any metal level, are qualified health plans.

Find out what Marketplace health insurance plans cover | HealthCare.gov

TOMORROW What is SHOP insurance?

Q&A Series: 15: What’s SHOP insurance?

DATE: 02-03-2025

Detailed image description:

The image is a promotional graphic for SHOP insurance information, featuring a bold header with "Q & A" in large, dark pink text against a colorful, abstract background with swirling patterns in brown, teal, and warm tones.

The main body consists of black text on a light beige background, explaining the SHOP insurance program. Key points are highlighted with bold text, including the acronym "SHOP" and criteria for qualifying for the Small Business Health Care Tax Credit. The graphic includes bullet points for clarity.

At the bottom, a bright pink and yellow banner with "JENSURANCE!" has additional contact information and a call-to-action with a black background featuring the text "Let's find your insurance solution" in yellow. Contact details are displayed in white against a colorful abstract design.

Text transcript:

Q: What is SHOP insurance? Who is it for? What does it do?

A: SHOP is the Small Business Options Program. It helps small employers offer affordable, private health & dental coverage.

It’s generally the only way to get the Small Business Health Care Tax Credit, which offers big savings for employers on their contribution.

Employer Guide to SHOP Insurance | CMS

The SHOP Marketplace offers quality plans from private insurance companies with standards for their plans like the ones from the Health Insurance Marketplace® (EHBs, pre-existing conditions protection, etc.). Employers can choose to offer medical, dental, or both & how much they contribute. Employers must employ at least 1 and no more than 50 full-time equivalent employees (FTEs).

To qualify for the Small Business Health Care Tax Credit:

• Have fewer than 25 FTEs (based on a 40-hour work week) making an average of about $56,000/yr. or less.
• Pay at least 50% of your FTEs' premium costs.

This tax credit can be worth up to 50% of your contribution toward premium costs (up to 35% for tax-exempt employers).

If eligible, employers need not wait for an Open Enrollment Period & can begin offering SHOP coverage at any time of year!

SHOP health insurance overview | HealthCare.gov

TOMORROW 02/04: What is an EPO plan?

Q&A Series: 16: What’s an EPO?

DATE: 02-04-2025

Detailed image description:

The image contains an informational graphic with a vibrant abstract background, featuring swirls of red, blue, and yellow at the top and bottom.

The main section is dedicated to a Q&A about insurance agents and brokers. The top left displays "Q&A" in bold black text on a pink background.

The central part is divided into two parts: a "Q" section with a question in bold, and an "A" section with a detailed explanation in smaller black text. Both sections are surrounded by black borders with colorful patterned backgrounds.

The bottom contains contact information overlaid on a bold black and pink strip labeled "JENSURANCE! LET'S FIND YOUR INSURANCE SOLUTION" in bright colors.

Text transcript:

Q: What is an EPO? What are the pros and cons compared with the other types of plans (HMO, PPO, etc)?

A: An exclusive provider organization (EPO) falls somewhere between an HMO and PPO.

An EPO provides the same covered services and lower costs of an HMO along with a broad network and some of the flexibilities of a PPO.

HMO, PPO, and EPO – What’s the Difference and Why Does It Matter? - CalPERS PERSpective

Key areas to remember:

• You pay copays, coinsurance, and deductibles. EPOs tend to have higher deductibles than HMOs. You’re required to obtain care from the plan’s network of preferred providers. If the network is too narrow, apply for a Network Gap Exception.
• If you receive care out-of-network, you’re required to pay the full cost of services (except for emergency care)
• You MAY have a primary care provider (PCP) but DON’T need a referral to see a specialist as long as they’re within the preferred provider network.

Pros: You don’t need a referral to see specialists. Some EPOs offer access to a broad network of providers. Many plans have lower monthly premiums than PPOs.

Cons: Specialists MUST be in-network for insurance to cover the visit. Mostly available in certain rural areas so check availability based on your location. Plans with lower premiums have more narrow networks.

What Is Exclusive Provider Organization (EPO) Insurance? - GoodRx