Common Insurance Questions and Answers

​​Health insurance protects you and your family from financial losses the same way home and car insurance work. Even if you’re in good health, you never know when you might have an accident or get sick. One key benefit of health insurance is access to a network of doctors, hospitals and other resources to help you stay healthy. ​​

If you purchase a health plan for yourself and your family, you have an Individual and Family plan. This means you don’t have coverage from an employer, Medicare or Medicaid. 

Individual and Family plans are plans you enroll in on your own during the Open Enrollment Period or during a Special Enrollment Period if you have a qualifying event. These plans cover a wide range of services and:  

• Last a year or longer 
• Can usually be renewed  
• Meet the essential requirements set by the Affordable Care Act (ACA), including: 
  • Emergency services, hospitalization, and preventive care
  • Maternity, newborn and pediatric care 
  • Mental health care and substance abuse treatment  
  • Lab services, prescription drugs, and disease management 
  • Rehabilitative services and devices 

If you enroll in an Individual and Family plan, you may be able to get help paying for it with a premium tax credit, known as a subsidy. Learn more about getting financial help to lower your monthly bill.

Medicare is coverage for people 65 and older — along with people under 65 with certain disabilities and illnesses. You can enroll in individual Medicare or get Medicare as a retiree through your employer. 

Original Medicare includes Part A (hospital) and Part B (medical). You can beef it up with additional coverage, including: 

• Part C – Medicare Advantage Plans offer all-in-one coverage, some with built-in prescription drug coverage.
• Part D – Prescription drug coverage pays for approved drugs not covered by Original Medicare Part A and B .
• Medicare Supplement Insurance Plans – Help pay for health care costs not covered by Original Medicare .

Need more information? Attend an event with us.

Medicaid is a joint federal- and state-funded program that provides health care coverage for low-income children and families, along with certain aged and disabled individuals. 

Medicaid and CHIP are types of low- or no-cost health insurance offered by the government. Your eligibility is based on your household size and income, and you can apply any time of year. If you qualify, coverage can start right away. 

• For Medicaid,  visit Medicaid.gov.
• For CHIP,  visit insurekidsnow.gov  or call  1-877-543-7669.  

Worried you may be having a heart attack? Did you black out after a nasty fall? Are you coughing up blood? Go to the hospital emergency room (ER) or call 911 when you have a medical emergency. ER doctors and staff are trained to treat serious and life-threatening health issues. Plus, the ER is open 24/7. Use Provider Finder^® to make sure a specific ER is in your plan’s provider network.

If you get your coverage through your employer, an association or other organization, you are in a group plan. 

Many plans cover health, dental, vision and more. Still, some may only cover health. You may need a separate policy for dental and vision coverage. 

Dental and vision insurance plans help cover dental and vision costs for you and your family. These types of plans can: 

• Cover a wide range of dental and vision services, including routine care like annual visits. 
• Be bought as part of your Individual and Family health plan or as stand-alone plans.  

Most health plans include prescription drug benefits. Medicare has a stand-alone prescription drug plan. Your coverage will depend on your plan. Some prescriptions, like specialty drugs used for chemotherapy, may be covered under your medical benefit. 

BCBSIL has in-network pharmacies, just like in-network doctors and hospitals. We secure discounts on drug costs by contracting with these pharmacies. Our network includes retail and local pharmacies in your area, plus national chains and mail order pharmacies.

Learn more about prescription drug coverage.

An HMO is a type of health plan that provides health care coverage to its members at a lower cost because you have one doctor, a primary care provider (PCP), coordinating your care. You’ll have lower copays and other out-of-pocket costs when you work with your PCP to schedule appointments with other health care providers. 

Learn more about HMOs.

If you like having the flexibility to choose the doctors, hospitals and other health care providers you use for care and you can afford to pay more, PPO insurance may be the right plan for you and your family.

PPO plans let you choose where you go for care. You don’t need a referral from a PCP. You aren’t limited to certain providers in your plan's network. PPO’s often have higher monthly premiums and out-of-pocket costs like copays, coinsurance and deductibles. With BCBSIL, there are different PPO plans to help meet your budget and health needs.

Learn more about PPOs.

A CDHP is a health plan with a health savings account (HSA) or other tax-advantaged account like a flexible spending account (FSA). These plans give members more control of health care expenses. 

Learn more about HSAs and FSAs.

An HSA is an account that you can use to pay for qualified medical expenses, including dental and vision services. 

Things to know about an HSA:

• Pre-tax contributions: If you are eligible for an HSA, you and your employer can make tax-free contributions (up to the annual limit) to your HSA.
• Tax-free withdrawals: As long as you are paying for a qualified medical expense, withdrawals from your HSA are tax-free. 
• Portability: Take your HSA account with you, even if you change jobs or health plans.

Learn more about HSAs.

An FSA is a CDHP where you use pre-tax dollars in your account to pay for qualified expenses. There are different types of FSAs but most common is one used for medical expenses. Sometimes it’s called a Health Care Flexible Spending Account (HCFSA).

You can choose to have an FSA if your employer offers it. You set aside a part of your earnings for the account. An FSA can be used along with any traditional health insurance plan.

Your employer owns your FSA. You can’t take your FSA account with you if you change jobs or retire.

Learn more about FSAs.