We get asked a lot of questions about health insurance. And for good reason—it’s complicated, the stakes are high, and there’s a lot of misinformation out there. Whether you’re looking for individual coverage, a group plan for your business, or just trying to make smarter financial moves, here are five of the most common questions we hear—and clear answers you can trust.
1. What is the difference between an HMO, PPO, and EPO?
These acronyms describe how your insurance plan works:
- HMO (Health Maintenance Organization): You need to pick a primary care doctor, and get referrals to see specialists. Coverage is limited to in-network providers. Lower premiums, but less flexibility.
- PPO (Preferred Provider Organization): No referral needed to see a specialist. You can go out of network, but it costs more. Higher premiums, but greater choice.
- EPO (Exclusive Provider Organization): A hybrid—you don’t need referrals, but there’s no out-of-network coverage.
TL;DR: If budget is a concern and you’re okay with less flexibility, HMO might work. Want more control? Look at PPO or EPO.
2. Can I change my health insurance plan outside of Open Enrollment?
Yes—but only if you qualify for a Special Enrollment Period (SEP). Common qualifying life events include:
- Getting married or divorced
- Losing other coverage
- Having a baby
- Moving to a new coverage area
No qualifying event? You’ll typically need to wait until the next Open Enrollment period.
3. How do I know if my doctor is in-network?
Always double-check with both:
- Your insurance company’s website
- The doctor’s office itself
Networks change all the time. If you see an out-of-network provider by accident, you could get stuck with a big bill.
Pro tip: Ask your provider for the exact insurance networks they accept, not just the insurance company name.
4. Does health insurance cover mental health services?
Yes. Thanks to the Mental Health Parity and Addiction Equity Act, most plans must cover:
- Therapy and counseling
- Inpatient psychiatric care
- Substance use treatment
Coverage may vary by plan, so check for:
- In-network therapist options
- Session limits or co-pays
- Pre-authorization requirements
Mental health is health—don’t skip it.
5. What is a Health Savings Account (HSA), and how does it work?
An HSA is a tax-advantaged account you can use to pay for qualified medical expenses. To be eligible, you need to be enrolled in a High Deductible Health Plan (HDHP).
Benefits:
- Contributions are tax-deductible
- Funds grow tax-free
- Withdrawals for qualified expenses are tax-free
Bonus: After age 65, you can use HSA funds for anything (taxed like a 401k if not for health expenses).
It’s one of the smartest tools for building long-term, flexible savings.
Want more help navigating your options? We offer no-pressure consultations to help you find the right plan for your health and your wallet.
✉️ Book your free meeting or call Shelia at (904) 295-8498.
Quick Tip Your health insurance isn’t just for emergencies—use it to stay ahead. Annual checkups, wellness visits, and screenings are often 100% covered. Don’t leave those benefits on the table.
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