Frequently Asked Questions
We know that residents of San Juan Capistrano, other Beach Cities and surrounding areas of Orange County often have in-depth questions not covered by our Insurance 101 page. Here are few questions we have received. We invite you to submit other questions you might have as a resource for future visitors to our site.
And the answer is...
It is tempting to consider going without health insurance when you are young and healthy. The trouble is that while younger people do not often have serious illnesses, they do have a high rate of serious accidents that can require hospitalization or medical attention. The best solution is to get a health insurance policy with a high deductible. Because the health insurance company is not paying for minor health costs, it can charge a much lower premium. At the same time, it will pay for the catastrophic injury or illness that could wipe out whatever savings and assets you might have.
And the answer is...
To avoid paying large fees when visiting the doctor, enroll in a traditional health insurance plan such as an HMO or PPO that is designed to cover regular well child visits, physicals, and exams.
And the answer is...
Many people persist with a health insurance plan they don't like out of fear of getting into a health insurance plan they like even less. The answer is to let a qualified health insurance professional like San Juan Capistrano Health Insurance shop around for the best plan at the best price. Changing plans does not have to be expensive. In fact, San Juan Capistrano Health Insurance recommends shopping for new health insurance every couple of years to make sure you are taking advantage of the best offers in the market.
And the answer is...
When you lose your health insurance or switch health insurance plans, you have 63 days to find a new plan to maintain "continuous" health insurance coverage. If your coverage lapses for more than 63 days, your coverage will not be deemed continuous, and your new insurer can delay or exclude coverage for a pre-existing condition. Keep in mind, however, that health insurance waiting periods do not count toward the 63-day period. For example, if you find a new employer within the 63-day period, you will be deemed to have continuous coverage even if the new employer requires 6-month waiting period before allowing you to enroll in the company's health insurance plan.
And the answer is...
If you’re losing your current health coverage or switching insurance, you might be concerned about whether or not your new insurance plan will cover a pre-existing medical condition. That is a medical situation that is still ongoing and is not considered to be the responsibility of the health insurance form that is selling you your new policy. Maintaining continuous coverage is the key to avoiding problems and that means there can’t be a lapse in your medical coverage of more than 63 days.
The 63-day rule applies to people who are leaving a group healthcare plan that they have typically obtained through their employer. Once a person leaves that plan, they have 63 days to find new coverage. If they have a lapse in their medical coverage that extends past 63 days, their coverage is not “continuous” and the health insurance company that is issuing their new plan can withhold or exclude coverage for a pre-existing medical condition.
Waiting periods do not count towards that 63 day period. So – if you obtain a new job that requires you and your family to wait 6 months to gain access to your new employer’s health plan, that new plan will still cover your pre-existing condition, provided that you don’t delay your enrollment! While the clock starts ticking the day your previous coverage ended, it does stop for the duration of your waiting period. But! Please don’t put your family and your finances at risk: Please talk with your health insurance expert here at the Fyrer Insurance Agency and learn how a short term health insurance plan can help bridge that critical gap between health coverage from past and current employers.
And the answer is...
HIPPA stands for Health insurance Portability and Accountability Act (HIPAA). Enacted in 1996, HIPPA protects your access to health insurance coverage when circumstances change in your life. For example, job loss, divorce, or relocation can require change in health insurance. HIPPA mandates that a person belonging to group health insurance plan must be allowed to purchase health insurance within a certain period that begins with the loss of the previous coverage.
And the answer is...
The answer depends on the size of your company. A company with 20 or more employees must provide you with the same health coverage it offers younger employees until you reach age 69. If that insurance is superior to Medicare, you can designate the company health insurance as your primary health insurance. It will pay benefits first, before Medicare is billed. In either case, be sure to enroll in Medicare Part A as soon as your are 65. It supplements your group coverage at no additional cost to you. You can delay enrolling in Medicare Part B to save on premiums, but delaying enrollment can be costly, too. We suggest that you speak with a health insurance professional at San Juan Capistrano Health Insurance when you reach age 65.
