Learn More

Frequently Asked Questions!

Check out the most common information requested and how to proceed. Health insurance can be confusing for several reasons: Complex Terminology: Terms like deductibles, copayments, coinsurance, and out-of-pocket maximums can be difficult to understand, especially for those unfamiliar with insurance jargon. Policy Details: Policies can have numerous provisions, exclusions, and conditions that are often written in complex legal language, making it hard to grasp what is covered and what is not. Cost Structures: Understanding how premiums, deductibles, copayments, and coinsurance interact can be confusing, especially when trying to predict out-of-pocket expenses. Changing Regulations: Health insurance regulations and policies can change frequently due to new laws and reforms, leading to uncertainty and the need to stay informed about the latest updates. Individual Needs: Each person's health needs and financial situation are unique, requiring a personalized approach to selecting and managing health insurance, which adds to the complexity. To navigate the complexities of health insurance, it can be helpful to work with an insurance agent or broker who can explain the options, answer questions, and provide personalized recommendations.

What Services Do We Offer?
The Menk Agency offers a wide range of solutions for you and your family. Products include Under 65 health insurance, Medicare, travel insurance, supplemental policies for income protection, and life insurance.
Which Plan Should I Get?
There are many different types of health insurance plans (e.g., HMOs, PPOs, EPOs, HDHPs), each with its own rules, coverage options, and network restrictions, making it challenging to compare and choose the right one. Reach out today for guidance
Will I qualify for a tax credit through Healthcare.gov?
The tax credit through the Affordable Care Act at Healthcare.gov is based on household size and income. If you qualify, this can reduce the amount you pay per month. You are also required to file taxes at the end of the year. Reach out to today to calculate your savings!
What is supplemental insurance?
Supplemental insurance provides a tax free lump sum of money to use for anything you need during a medical event. This includes bills, travel and housing costs. Medical events include cancer, heart attack, stroke, accidents, and hospital stays.
Can I get Health Insurance for $0?
With the Affordable Care Act and tax credit eligibility, you can get plans for $0 per month. However, sometimes you get what you pay for and this may leave you exposed and at risk for certain medical events.
Am I eligible for Medicare?
Medicare eligibility starts a age 65. Be on the lookout for the Red, White, and Blue Card. You are automatically enrolled in Part A and Part B will be paid each month either through bank account or deduction from retirement benefits. You may also be eligible for Medicare if you on federal disability and Medicaid. It can be confusing so we are here to help!
Why Should I get Life Insurance?
Financial Protection for Loved Ones: Life insurance ensures your family can cover essential expenses, such as living costs, mortgage payments, and educational fees, in the event of your death. Debt Repayment and Final Expenses: It helps pay off outstanding debts and covers funeral and burial costs, preventing financial strain on your family during a difficult time. Peace of Mind and Estate Planning: Life insurance provides peace of mind by ensuring your loved ones are financially secure and helps in estate planning by covering taxes and facilitating the smooth distribution of assets.
Why Should I work with an Agent?
Working with an insurance agent can provide several significant advantages: Expert Guidance: An insurance agent has extensive knowledge of various insurance products and can help you understand complex policy details, ensuring you choose the right coverage for your needs. Personalized Service: Agents can assess your unique situation and recommend policies that best fit your personal and financial circumstances, providing tailored solutions. Claims Assistance: In the event of a claim, an agent can guide you through the process, help with paperwork, and advocate on your behalf to ensure a smooth and efficient resolution. Time and Effort Savings: Agents do the legwork of researching and comparing different insurance options, saving you time and effort in finding the best policy at the most competitive price. Ongoing Support: An agent can provide ongoing support and advice as your insurance needs change over time, ensuring your coverage remains adequate and up-to-date.
Can I Go to Any Doctor?
Provider networks in health insurance refer to the group of doctors, hospitals, and other healthcare providers that have agreed to provide medical services to the insurance company's policyholders at negotiated rates. Here’s a detailed explanation: In-Network Providers: These are healthcare providers who have contracted with your insurance company to offer services at predetermined rates. Using in-network providers usually results in lower out-of-pocket costs for policyholders because of these negotiated rates. Out-of-Network Providers: These providers have not contracted with your insurance company. Receiving care from out-of-network providers typically results in higher out-of-pocket costs for the policyholder, as the insurance company may cover a smaller percentage of the costs or none at all. Types of Plans: HMO (Health Maintenance Organization): Requires members to use in-network providers for all non-emergency care and typically requires a referral from a primary care physician to see a specialist. PPO (Preferred Provider Organization): Offers more flexibility, allowing members to see any healthcare provider, but providing better coverage and lower costs for in-network services. EPO (Exclusive Provider Organization): Requires members to use in-network providers, except in emergencies, but does not typically require referrals to see specialists. POS (Point of Service): Combines elements of HMO and PPO plans, requiring a primary care physician referral for specialist care, but offering some out-of-network coverage at higher costs. Cost Savings: Insurance companies negotiate rates with in-network providers to control costs. Policyholders benefit from these lower rates through reduced premiums, copayments, and coinsurance when they use in-network services. Quality Assurance: Insurance companies often evaluate the quality of care provided by in-network providers to ensure they meet certain standards, which can give policyholders confidence in the level of care they receive. Understanding your plan's provider network is crucial for managing healthcare costs and ensuring you receive the maximum benefits from your health insurance policy. Always check whether a healthcare provider is in-network before receiving services to avoid unexpected expenses.

Insurance Can Be Confusing!

Common Terms and What They Mean

All the terms for insurance can be overwhelming. Here are some definitions that may help you discuss best options.

What is a Premium?
An insurance premium is the amount of money you pay to an insurance company for coverage under an insurance policy. This payment can be made on a regular basis, such as monthly, quarterly, semi-annually, or annually. In exchange for paying the premium, the insurance company agrees to provide financial protection against specified risks, such as health issues, accidents, property damage, or death, depending on the type of insurance policy you have. The amount of the premium is determined by factors such as the type and amount of coverage, your risk profile, and any applicable discounts or credits.
What is a Deductible?
A deductible in insurance is the amount of money you must pay out of pocket before your insurance company starts to cover the remaining costs of a claim. It is a form of cost-sharing between you and the insurer. Here’s how it works: Higher Deductible, Lower Premium: Generally, choosing a higher deductible will result in lower premium payments. Conversely, a lower deductible means higher premiums. Claim Process: When you make a claim, you pay the deductible amount first, and then the insurance company pays the covered expenses that exceed this amount.
What is a Copayment?
A copayment, or copay, in insurance is a fixed amount that you pay out of pocket for a specific healthcare service or prescription medication at the time of service. This payment is typically required after you have met any applicable deductibles under your insurance plan. Here’s how it works: Fixed Amount: The copay is a set fee, such as $20 for a doctor’s visit or $10 for a generic prescription, regardless of the actual cost of the service or medication. Service-Specific: Copay amounts can vary depending on the type of service. For example, a visit to a specialist may have a higher copay than a visit to a primary care physician. After Deductibles: In some plans, copays apply only after you have met your deductible, while in others, they apply immediately without needing to meet a deductible first.
What is the Out of Pocket Max?
The out-of-pocket maximum (OOPM) in insurance is the most you will have to pay for covered healthcare services in a plan year. Once you reach this limit, your insurance company pays 100% of the costs for covered benefits. Here’s how it works: Includes Deductibles, Copayments, and Coinsurance: The OOPM typically includes all your out-of-pocket costs such as deductibles, copayments, and coinsurance. However, it does not include your premium payments. Protection from High Costs: The OOPM provides a cap on your healthcare spending for the year, protecting you from excessive medical expenses in case of major health issues. Plan Year Basis: The OOPM resets each plan year. Once the new plan year begins, you start contributing towards the OOPM again. For example, if your plan’s OOPM is $6,000 and you have already paid $6,000 out of pocket for covered services, any further covered medical expenses for the remainder of the plan year will be fully paid by your insurance company.
img
img
img

We are Here to Help

Let Us Find You the Best Insurance

The Menk Agency is dedicated to providing comprehensive health insurance solutions, with a strong emphasis on personalized client care.

Latest Portfolio

Need Any Help? Or Looking For an Agent

Working Hours : Mon-Fri, 9 AM-6 PM
© 2024 The Menk Agency. All Rights Reserved.