Question 1

What is the ACA Marketplace?

Accepted Answer

The Affordable Care Act (ACA) Marketplace is a federally regulated platform for buying health insurance. All plans must cover Essential Health Benefits and cannot deny coverage for pre-existing conditions.

Question 2

What is a PPO plan?

Accepted Answer

A Preferred Provider Organization (PPO) plan gives you flexibility to see any doctor, including out-of-network providers, without needing a referral.

Question 3

What is a deductible?

Accepted Answer

A deductible is the amount you pay for covered services before your insurance starts paying. For example, a $2,000 deductible means you pay the first $2,000 of covered costs.

Question 4

What is a copay?

Accepted Answer

A copay is a fixed amount you pay for a covered service, like $30 for a doctor visit, usually at the time of service.

Question 5

What is coinsurance?

Accepted Answer

Coinsurance is your share of the costs of a covered service after you've paid your deductible, usually a percentage like 20%.

Question 6

Are prescriptions covered?

Accepted Answer

Most ACA and PPO plans include prescription drug coverage. Formularies (drug lists) vary by carrier and plan tier.

Question 7

When is Open Enrollment?

Accepted Answer

For ACA Marketplace plans, Open Enrollment typically runs from November 1 to January 15 in most states. Some states have extended periods.

Question 8

What is a Qualifying Life Event?

Accepted Answer

A Qualifying Life Event (QLE) like marriage, birth of a child, loss of coverage, or moving allows you to enroll outside Open Enrollment via a Special Enrollment Period.

Question 9

Can small businesses offer health insurance?

Accepted Answer

Yes. Businesses with 2+ employees can offer group health, dental, vision, and supplemental coverage through the SHOP Marketplace or off-exchange.

Question 10

Is dental coverage included?

Accepted Answer

Standalone dental plans are available for individuals, families, and small businesses. Some ACA plans include pediatric dental.

Question 11

Is vision coverage included?

Accepted Answer

Standalone vision plans are available, and some group plans bundle vision with medical coverage.

Question 12

How does family coverage work?

Accepted Answer

A single family plan covers you, your spouse, and eligible dependents under one deductible and out-of-pocket maximum structure.

Question 13

Who is eligible for ACA subsidies?

Accepted Answer

Households earning between 100% and 400% of the federal poverty level typically qualify. Recent legislation expanded eligibility above 400% in many cases.

Question 14

What is a provider network?

Accepted Answer

A network is the group of doctors, hospitals, and providers that have agreements with your insurance carrier for negotiated rates.

Question 15

How much does health insurance cost?

Accepted Answer

Costs vary based on plan tier, age, location, tobacco use, household size, and subsidy eligibility. A licensed ClearGuard agent can give you an exact quote in minutes.

Question 16

How do I file a claim?

Accepted Answer

For in-network care, providers file claims directly with your carrier. For out-of-network care on a PPO, you may need to submit a claim form.

Question 17

What is the out-of-pocket maximum?

Accepted Answer

This is the most you'll pay in a plan year for covered services. Once you hit it, your insurance pays 100% of covered costs for the rest of the year.

Question 18

Do you offer plans in every state?

Accepted Answer

ClearGuard has nationwide carrier access. Availability of specific plans depends on your state and county.

Question 19

How long does enrollment take?

Accepted Answer

Most enrollments can be completed same-day. Coverage typically starts the first day of the following month.

Question 20

Can I keep my doctor?

Accepted Answer

That depends on the plan network. Our agents will confirm your preferred providers are in-network before you enroll.

Question 21

What if I lose my job?

Accepted Answer

Losing employer coverage is a Qualifying Life Event and opens a Special Enrollment Period. We can help you compare COBRA and ACA options.

Question 22

Are pre-existing conditions covered?

Accepted Answer

Yes. All ACA-compliant plans cover pre-existing conditions and cannot charge more based on health history.

Question 23

How do subsidies work?

Accepted Answer

Subsidies are advance premium tax credits paid directly to your carrier to reduce your monthly premium.

Question 24

Are supplemental plans worth it?

Accepted Answer

Supplemental coverage like accident, critical illness, and hospital indemnity can protect against unexpected costs — especially on high-deductible plans.

Question 25

Do you charge a fee?

Accepted Answer

No. ClearGuard is compensated by the carriers we partner with. Our service to you is 100% free.

Question 26

Is my personal information secure?

Accepted Answer

We handle information with care and follow HIPAA-conscious data practices. We never sell your data.

Question 27

How do I contact a licensed agent?

Accepted Answer

Call (866) 776-1410 during business hours (Mon–Fri, 9 AM–6 PM EST) or request a quote and we'll reach out.

Question 28

Can I switch plans mid-year?

Accepted Answer

Only during Open Enrollment or a Special Enrollment Period triggered by a Qualifying Life Event.

Question 29

What are HSAs and HRAs?

Accepted Answer

Health Savings Accounts (HSAs) and Health Reimbursement Arrangements (HRAs) are tax-advantaged accounts used with qualifying plans to pay medical expenses.

Question 30

Do you help with Medicare?

Accepted Answer

ClearGuard specializes in under-65 health coverage. We can refer you to trusted Medicare specialists for supplement and Advantage plans.

Answers to your health insurance questions

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