Does it cost me anything to work with an insurance agent?

No. You are not charged an increase in premium for working with an agent.
The insurance company you select will compensate the agent.


What are the advantages of working with an insurance agent?

If you have an agent you can develop a long lasting relationship with them and they will be there for you when you need help with your insurance policy.


Why do my health insurance rates increase?

Medical spending drives rates up. The costs of medical services can go up for many reasons, like physicians or laboratory charges, more use of health care services, new technologies, prescription drugs, an aging population, and unhealthy lifestyles. Companies must charge enough to cover their projected claims and administrative costs.


Why did my rate go up when I did not have any claims?

Insurance is bought to protect you from the full financial burden of unexpected medical events. Insurance is the pooling of risks, so individuals pay a share of the pooled experience in exchange for coverage. If it was not shared in this way, everyone would have to pay the full rate for their own claims; that would not be insurance.


How often can my rates go up?

Generally, an individual health plan may not raise premiums more than once every 12 months. Another reason your rate may change is due to reaching a higher age bracket. As you age you could move into an age band where the rates are higher.

If I am already covered by Medicare do I need to make a change now that these Affordable Care Act (ACA) or marketplace plans are available? Will my Medicare be recognized by law?

The government recognizes Medicare coverage as insurance coverage, thereby satisfying the individual mandate that all adults need to carry health insurance. You will not be penalized if you choose to stay covered by Medicare.


What if I am covered by Medicare, but would like to purchase one of the ACA plans? Is that an option or would you suggest keeping my Medicare coverage?

We suggest keeping your Medicare coverage, as the companies who sell ACA plans are actually prohibited from selling them to you if they are aware that you are covered by Medicare. If you drop Medicare so that you may enroll in an ACA plan – you may face a penalty for late enrollment. It would be best to remain with Medicare. Premiums for ACA plans may vary by age and state. Though a few states prohibit adjustments to premiums based on age, most states’ premiums for those over 65 years old could cost up to three times more than it would for a person in their early 20s.


If I am covered by Medicare and my annual income is $30,000, do I qualify for a premium tax credit to help me pay for my health insurance coverage?

No. Anyone covered by Medicare, regardless of income level, is ineligible for premium tax credits.


I am over 65 and a legal U.S. resident, but I don’t qualify for Medicare. Can I apply for coverage and subsidies in the ACA marketplace?

Yes. Generally speaking, anyone aged 65 or older who is not eligible for Medicare may purchase ACA coverage. If your income is between about 100% and 400% of the federal poverty level (about $11,770 to $47,080 for an individual in 2015) you may be eligible for premium tax credits.


I am over 65 years old and work for a large employer who offers excellent health insurance coverage. I plan on working for several more years and would like to continue using my employer’s healthcare plan. Does the ACA affect me?

No, the ACA will not affect your ability to use your employer’s health insurance. As long as you are covered by insurance, you are satisfying the individual mandate, that all adults need to carry health insurance. You will not be penalized if you choose to stay covered by your employer’s plans. However, you should plan to sign up for Medicare when you decide to stop working, or if you lose employer coverage, since you are already eligible for it.


I am in my early 60s and plan to sign up for a Marketplace plan until I qualify for Medicare at age 65. What should I do when I am eligible for Medicare?

You may begin the sign-up process for Medicare three months before you turn 65 years old. You should alert your ACA plan providers that you will be making the switch. Make sure not to drop your ACA plan until your Medicare coverage is active, in order to avoid gaps in coverage. Keep in mind that any premium tax credits you receive on you ACA plan will end when your Medicare plan begins.


Can I purchase Medicare Advantage plans, Medicare Part D drug plans or Medigap policies through the ACA marketplace?

No, Medicare plans will continue to be available as they have been. You may enroll in a Medicare Advantage plan or a Medicare Part D plan on the Medicare website or directly through the Wooten Agency or any other company who offers these plan. Feel free to reach out to the experts at the Wooten Agency today to learn more about Medicare coverage options, including Medicare Advantage Plans, Part D drug plans, and Medigap supplements.


If I am enrolled in a Medicare Part D drug plan, were changes made to my Medicare drug coverage as a result of the Affordable Care Act?

Yes, the ACA includes changes that may help you save on prescription drug costs over the years. If you have very high drug costs on your Medicare Part D plan, you may benefit from the new law. The gap in coverage will be phased out between now and 2020. For example, in 2014, after your total drug costs reach more than $2,850, you will pay 47.5% of the cost of your brand-name drugs and 72% of the cost of your generic drugs. The ACA ensures that these amounts will gradually be lowered to 25% for both brand-name and generic drugs by 2020.


If I am enrolled in a Medicare Advantage plan, were changes made to my program as a result of the Affordable Care Act?

Yes. The Medicare Advantage (MA) plan is an alternative to traditional Medicare, in which MA recipients enroll in a private plan in order to receive Medicare benefits. The ACA reduced payments to these private plans to bring them closer to the average costs of traditional Medicare, while providing additional compensation to plans that earn high quality ratings. New protections for those enrolled in this type of plan limit how much companies are allowed to charge for cost sharing, administrative expenses, and profits. However, your plan may charge higher premiums, increase cost-sharing amounts, reduce the number of providers in its network, or reduce additional benefits as a result of this.

What does life insurance cover?

Life insurance can be used to cover a variety of common expenses like:

        • Co-signed debt including student loans
        • Mortgages
        • College expenses for the kids
        • Living expenses for your family
        • Stay-at-home labor expenses (cooking, cleaning, etc.)
        • Burial expenses
        • Loans from family members
        • Estate taxes that your heirs must pay for other assets


What is a beneficiary?

The beneficiary is the person or entity named as the recipient of your policy’s death benefit. It can be a family member, a person unrelated to you, or even a business or other organization.

You choose the beneficiary on your own—you don’t need permission from the insurer or the beneficiary. You can also choose more than one beneficiary and designate how you want the death benefit to be split among them.


What does the beneficiary need to do to receive a death benefit?

Technically a beneficiary does not have to do anything to receive your policy’s death benefit.

Your insurer will automatically disburse the death benefit if you die, but it’s still a good idea to tell any beneficiary about the policy so he or she will be prepared to take action should a problem arise. For this same reason, it’s also a good idea to provide the beneficiary with access to the contract.

The insurer will require proof of death and a copy of the contract in order to disburse the benefit.


Is the life insurance I receive through work enough?

Many employers offer life insurance through their benefits packages, but these policies alone are not usually enough to guarantee that your family will not experience a financial burden. It is important to remember that the policy is only in effect, or “good,” as long as an individual is employed with that company.


Are my insurance premiums tax-deductible?

Paid insurance premiums are not tax-deductible.


What happens if I miss a payment or am late on a monthly payment?

If you miss a premium payment, you typically have up to a 31-day grace period during which you can pay the premium with no interest charged.

When can I sign up for an ACA plan?

You may sign up for an ACA plan during open enrollment: November 1, 2018 – December 15, 2018.

What if I do not sign up during open enrollment?

If you miss the deadline for Open Enrollment, you may be eligible to enroll during Special Enrollment Periods. Don’t panic – our agents will walk you through your options.

Can insurers deny me coverage because I have a pre-existing medical condition?


Are preventive services included in all ACA plans?

Yes! All ACA plans must cover these preventive services at no cost to you. That means you won’t be charged copayments or coinsurance, even if you have not met your annual deductible.

If I am on insurance offered through my employer may I purchase a more affordable or comprehensive ACA plan?

You may. However, please note that you may not be eligible for a subsidy unless the premium for your employer-provided insurance is more than 9.5% of your annual household income.

What if I cannot afford the premiums for a new ACA plan?

The ACA offers subsidies for many people, based on their estimated yearly income, to lower monthly premiums. Under certain circumstances, you can receive help for deductibles and co-payments as well. Additionally, you may qualify for Medicaid assistance.

To discuss your options and receive advice for your particular situation, please contact us! We are happy to show you what you qualify for. Additionally, we can explain what alternative coverage options (Short Term Insurance, Health Care Share Organizations, etc.) are available to you.

Whatever your needs and circumstances, we will work to find you the best and most affordable health care coverage.

What if my income estimate for next year is incorrect?

Estimating your income from year to year can be difficult. Don’t worry, you’re not alone! As you experience income changes, notify your agent or in order to make appropriate adjustments to your subsidy. If you do not notify your agent of an income change, you may miss out on valuable savings on your premium – or you may be required to pay back your subsidy.

What if I choose not to purchase health insurance?

If you choose not to purchase health insurance in North Carolina, you will not be penalized in 2020. However, we recommend you discuss your current health status and your decision with an agent first to ensure you’re protected against unnecessary fees and unexpected medical costs.