Question 1

Is it required to buy health insurance? Is there a penalty if I don't purchase health insurance?

Accepted Answer

Yes, currently the penalty for not having coverage the entire year will be at least $900 per adult and $450 per dependent child under 18 in the household when you file your state income tax return. A family of four that goes uninsured for the whole year would face a penalty of at least $2,700.

If you apply for health insurance through Covered California, you will still have the opportunity to apply and qualify for subsidies. The Open Enrollment Period for purchasing health insurance in 2025 starts from November 1, 2024 and ends on January 31, 2025. If you would like your policy to become effective on January 1, 2025, then you will need to enroll and submit your application by December 31, 2024.

During this Open Enrollment Period, you can also update or change your health plan if you would like to do so. If you miss this time period, you will not be able to purchase health insurance at any point for the rest of the year, unless you qualify for special enrollment.

Question 2

What is the penalty if I don’t have health insurance?

Accepted Answer

Currently the penalty for not having coverage the entire year will be at least $900 per adult and $450 per dependent child under 18 in the household when you file your state income tax return. A family of four that goes uninsured for the whole year would face a penalty of at least $2,700.

Question 3

Do I qualify for special enrollment?

Accepted Answer

You qualify for a special enrollment period 60 days following certain life events including:

Legal separation or divorce

Marriage or domestic partnership

Cessation of dependent status (attaining the maximum age to be eligible as a dependent child)

Birth, adoption, or placement for adoption

Loss of coverage due to termination of employment or reduction in the number of hours of employment

Relocating to California

Returning from military active duty

Release from incarceration

Question 4

Do I qualify for federal subsidies?

Accepted Answer

Covered California and the IRS are connected in the sense where Covered California uses the household income and household size on the 1040 tax form to calculate health insurance premiums and check for eligible federal subsidies for the applicant.

Based on your annual household income, you may qualify for federal subsidies in the form of Medi-Cal, premium assistance, or cost-sharing reductions.

As long as you are a resident with a taxable income, you are required to have health insurance whether it’s through your employer, Covered California, etc. If you do not, you will be penalized and fined. To determine whether you qualify for premium assistance, please refer to the chart below:

Question 5

What are HMO, EPO and PPO?

Accepted Answer

Here are the main differences among the three plans:

When choosing a health plan, take into consideration you and your family’s needs. If you have a primary care physician you want to see, make sure your primary care physician is in that network.

Question 6

Which health insurance plan should I choose?

Accepted Answer

There are three types of plans: HMO, EPO, and PPO. In order to ensure that your family member receives the most health benefits at an affordable cost, please consult KCAL Insurance, a Covered CA Certified Insurance Agent, to help you find the most suitable health plan for you.

There are plenty of individual health insurance plans to choose from. Here are the most common types:

HMOs (Health Maintenance Organization). HMOs are one of the most affordable health plans available, and they offer comprehensive coverage. HMOs create networks of doctors, hospitals, clinics, specialists, and other care providers. Most HMO networks consist of thousands of health care professionals, ensuring you’ll have convenient access to medical care when you need it.

PPOs (Preferred Provider Organization). PPOs are affordable individual health insurance plans with an added benefit – you’ll have coverage with any health care provider. That means you can see any doctor or specialist you want, and your plan will cover the care. PPOs are great for flexible, comprehensive, and affordable health care.

Health Savings Account (HSA) Plans. There are 2 parts to HSA coverage: a high-deductible plan and a Health Savings Account. The high-deductible plan provides catastrophic coverage and features low monthly premiums. The HSA is a tax-free savings account where you save money to pay for routine medical expenses.

Fee For Service (FFS) Plans. FFS plan is a traditional form of individual health insurance. You get the care you need and then you’re reimbursed for a percentage of the cost.

Question 7

What are Obamacare's Essential Health Benefits?

Accepted Answer

Ambulatory patient services

Emergency services

Hospitalization

Maternity and newborn care

Mental health and substance use disorder services, including behavioral health treatment

Prescription Drugs

Rehabilitative and habilitative services and devices

Laboratory services

Preventive and wellness services and chronic disease management

Pediatric services, including dental and vision care

Related reading: Take Advantage of Obamacare’s 10 Essential Benefits

Question 8

When can I apply for health insurance?

Accepted Answer

The 2026 Open Enrollment Period starts on November 1, 2025. Please feel free to contact us at KCAL! We’d be more than happy to help you enroll or switch insurance plans for 2026!

Open enrollment for Covered California health insurance plans happens once a year. During this open enrollment period, individuals can enroll, switch plans, and get subsidies. Unless you meet special conditions, open enrollment is the only time of year you can get a major medical plan that counts as minimum essential coverage in the individual and family market.

Question 9

Can I apply for healthcare at any time?

Accepted Answer

Unless you qualify for special enrollment, you can only purchase health insurance during the Open Enrollment Period, which occurs only once a year.

The 2026 Open Enrollment period starts on November 1, 2025 and ends on January 31, 2026. If you’d like your policy to become effective by January 1, 2026, you must apply by December 31, 2025.

Question 10

How can I apply for health insurance?

Accepted Answer

KCAL Insurance is a Covered CA Certified Insurance Agent, with more than 100 insurance agents. We are professionally trained to help you choose a health plan that is most suitable for you and to help you apply for government premium assistance. If you wish to apply for Covered CA, please bring the following documents to any KCAL office for our agents to assist you:

Social Security Number (SSN) of entire household

Proof of citizenship (U.S. passport) or proof of residence (i.e. green card) for entire household

2021 tax forms

Proof of wages from the past month

If you are already a Covered CA member, please bring the additional documents with you when you come to our office:

Current health insurance information (insurance card)

Covered CA renewal notice that you received in the mail (green envelope)

Question 11

How do I calculate my monthly premium and subsidy amount?

Accepted Answer

Covered CA partners with the IRS to determine the premium and subsidy amount based on a family’s household income, which is reported on the 1040 tax form each year.

Question 12

How can I lower my monthly premium?

Accepted Answer

Move to a higher deductible plan. If you are a young, healthy individual who doesn’t anticipate any major health problems, you may want to switch to a higher deductible. Your premium will become significantly lower! However, if you are certain of high medical expenses, then the opposite would apply. You may want to switch to a plan with both a lowest possible deductible and lowest out-of-pocket expenses.

Question 13

What will my deductible be?

Accepted Answer

Whether the insurance is individual or group, the amount of the deductible is determined at the time the policy is written and is decided by the person, group or business which sets up the health plan. You will also have out-of-pocket expenses besides the deductible mentioned above. These include the percentage of fees your plan does not pay and any uncovered medical services not included in your insurance policy.

Question 14

How can I insure just my child?

Accepted Answer

When getting quotes for your child(ren) only, enter the child’s gender and birth date in the “Applicant” or first row. Additional children should be entered below in the “Child” rows, but not the “Spouse” row.

However, many health insurance companies require one policy per child. So if you have more than one child, try entering just one child to see a larger selection of plans and prices. Feel free to apply for each child separately.

Question 15

When should I consider a Health Savings Account (HSA)?

Accepted Answer

Health Savings Accounts (HSAs) are becoming increasingly popular due to their flexibility and immediate tax savings. This plan is suitable for people who seldom need medical care but would like to prepare for any catastrophic ailments or injuries. Who is eligible for Health Savings Account?

Not entitled to benefits under Medicare

Be covered under a high deductible health plan

May not be covered under any health plan that is not a high deductible health plan

Not be claimed as a dependent on another person’s tax return

What are the advantages?

Contributions to the account are tax deductible

Amounts in an HSA belong to the individual and are fully portable

Amounts in an HSA earn tax-free interest

Unused amounts in the account at year-end remain available for future years

Distributions are not taxed if used for qualifying medical expenses

Question 16

Who should buy individual health insurance?

Accepted Answer

Anybody who does not have insurance. This may be for several reasons:

Self-employed.

People who work for a small business that does not provide a health plan.

Those who do not obtain individual health insurance.

Question 17

Can individuals with pre-existing conditions apply for health insurance?

Accepted Answer

Yes. Beginning in 2014, insurance companies can no longer deny coverage to individuals based on pre-existing conditions.

Question 18

What is Workers' Compensation Insurance?

Accepted Answer

Workers’ Compensation Insurance is required in most states when you have W-2 employees. In some states the requirement may include that you cover your 1099 contractors. Workers’ Compensation insurance covers your employees’ medical and disability expenses caused by work-related illness and on-the-job injuries. In some states, owners, officers, partners and other principals can decline to participate in their own companies’ workers’ compensation coverage.

Employer’s Liability coverage, also included in these policies, protects your company in the event that an employee claims that his or her injury or illness was caused by your company’s negligence or failure to provide a safe workplace.

Question 19

What are the benefits of Workers' Compensation Insurance?

Accepted Answer

Workers’ compensation insurance provides for the well being of your employees and promotes a positive work environment. Be aware that some states have passed laws that make workers’ compensation mandatory once a business expands to four or more employees on payroll. Workers’ compensation insurance was created in order to pay employees’ medical expenses and loss of wages in the event of a job related injury or sickness.

Question 20

What does Workers’ Compensation cover?

Accepted Answer

Workers’ Compensation Insurance covers all employees’ approved medical costs, temporary and permanent disability payments, and death compensation caused from work-related injuries or illness.

Question 21

What are the penalties for not having Workers’ Compensation?

Accepted Answer

If the Division of Labor Standards Enforcement (DLSE) determines that an employer is operating without workers’ compensation coverage, they will face fines and penalties:

1. The DLSE can issue a stop work order and require employers to cease all business operations at the worksite until they furnish proof of workers’ compensation insurance.

2. Employers are still required to pay salaries until they reopen.

3. The DLSE will assess a penalty of a minimum of $1,500 up to $100,000 per employee.

4. If an employee gets hurt or sick because of work and the employer is not insured, the employer is responsible for paying all the bills related to the injury or illness.

Question 22

How is workers’ compensation premium calculated?

Accepted Answer

Premiums for workers’ compensation insurance are calculated by the formula below:

Payroll x Classification Rate x Experience Modifier = Premium

Workers’ compensation premium is based on the estimated amount of payroll paid to employees during the 12-month policy period. Employers can make a single payment or in a monthly installment.

After the 12-month policy has lapsed, insurance companies will require employers to check the actual payrolls that were paid to employees, which could result in additional premiums being due or a decrease in premiums at the end.

Question 23

Do I need to post a Labor Law Poster?

Accepted Answer

California law requires employers to post an updated Labor Law Poster annually in a conspicuous place where employees can easily see it during the workday. Any employer that fails to post the poster may be subject to citation and penalty up to $10,000.

The poster must state the name of the current workers’ compensation insurance carrier, the policy number and contact information. Employers also have to put the information of the workers’ compensation network next to the Labor Law Poster.

Question 24

How do I get the Labor Law Poster?

Accepted Answer

You can get a free Labor Law Poster from our branch nearest you, or call us at 1-800-681-8288.

Question 25

Am I covered under my personal policy if I also use my auto for business?

Accepted Answer

If you own your car and simply drive to and from your principal place of business, this is considered personal use and will be covered under your personal policy.

If in addition to commuting to work, you also use your vehicle for other business-related driving, such as traveling on sales calls or carrying tools, supplies, and equipment to a job site, this is considered business use. It may or may not be covered under your personal policy.

To ensure that you have the appropriate insurance for your needs, consult with a qualified insurance representative and check your policy for restrictions.

Question 26

If I borrow someone else's car, what insurance pays?

Accepted Answer

If you’re driving someone else’s car and you get into an accident, the insurance on the borrowed car would be prioritized to pay for damages first. Your own auto insurance will serve as a secondary source if coverage on the first car was exhausted. See policy for details.

Question 27

Can I convert my policy from term to permanent?

Accepted Answer

Yes, you can convert all or some of your term coverage to a permanent policy for a lifetime of coverage.

Question 28

Do I need comprehensive and/or collision on all my autos?

Accepted Answer

You can make comprehensive and/or collision coverage choices individually for each of your insured vehicles.

Question 29

After an accident, how do I file a claim against the other driver?

Accepted Answer

You can file a claim against the other driver by contacting that person’s insurance company or agent. You will need to give the other party’s insurance company your insurance information and let them know the type of claim you wish to make. If you need assistance, contact a KCAL Insurance claim professional.

Question 30

Does my auto insurance policy cover rental vehicles?

Accepted Answer

Yes! At KCAL Insurance, the same coverage you have on your current auto policy also applies to any car you rent. So, for example, if you have collision and comprehensive coverage on your current auto policy, you’ll also have them when you’re renting a car for vacation, a pick-up truck for moving, or a temporary vehicle while yours is in the shop. Be aware that other insurance companies may not cover rental cars automatically.

Question 31

How can I save money on auto insurance?

Accepted Answer

There are many things you can do to make sure you’re getting the best premium possible.

Increase your deductible

Maintain a good driving record

Maintain a good credit rating

Take a driver safety course

Research before buying. Learn which cars are the least expensive to insure. KCAL Insurance offers discounts for cars that have anti-theft devices, air bags, and anti-lock brakes, for example. KCAL Insurance can give you free, no-obligation quotes on any cars you’re considering purchasing; just call us with the VINs of the vehicles you’re interested in buying. Take advantage of KCAL Insurance’s multi-policy discounts, which provide discounts on certain coverage when you purchase two or more policies, such as an auto and homeowners policy.

Question 32

How much auto insurance do I need?

Accepted Answer

How high should my liability coverage limits be? No one can predict exactly how much you would have to pay if you were to cause an accident. Ask yourself how you would pay for any damages exceeding your coverage limits. The higher your liability coverage limits are, the more likely your policy will be able to pay all of the damages.

How high or low should my collision and comprehensive deductibles be? Higher deductibles lower your premium but increase the amount you must pay out of your own pocket if a loss occurs. Ask yourself how much you would be willing and able to pay on short notice in order to save on your premium.

Should I carry collision and comprehensive coverage?

You may be required to carry collision or comprehensive coverage if your vehicle is leased or financed. Once you have paid off your car, and its value decreases, you might consider dropping this coverage to save money on premiums. However, consider whether the savings would be enough to offset the risk of having to pay the entire cost of repairing or replacing the vehicle.

Question 33

How much liability coverage do I need?

Accepted Answer

Auto insurance, like all types of insurance, will protect you against a financial loss if you are involved in an auto related accident. All 50 states require a minimum liability insurance to legally operate a vehicle on a public road, which differs from state to state. Buying insurance at these minimum limits will be enough to legally operate a vehicle on the road but usually it’s not adequate protection. If you are at fault for an accident, your auto liability insurance will pay for the other party’s injuries and damage to their car or property. The insurance company will defend the lawsuit at their expense, so the coverage limits will not be affected. If the insurance company pays the full limit of insurance, thereby exhausting all coverage, the responsible party or vehicle owner may be sued or may have to pay out of pocket for the other person’s loss.

Question 34

If I loan my car, would I be covered if there's an accident?

Accepted Answer

Yes. With a KCAL Insurance auto insurance policy, anyone who drives your car with your permission is covered under your policy. See policy for details and restrictions. Note: If someone pays you to use your car, you will not be covered.

Question 35

Should I buy extra insurance protection on a rental car?

Accepted Answer

The coverage you have on your current auto policy also applies to the cars you rent. But if you don’t carry collision or comprehensive on at least one insured vehicle, you may not have this coverage on a rental car, depending on state law. To be safe, check with your agent or call KCAL Insurance’s customer service center to confirm your coverage.

Question 36

What discounts are available for auto insurance?

Accepted Answer

Discounts, Discounts, Discounts. Auto insurance companies have a variety of discounts available to help lower your insurance cost, but the discounts may vary from company to company. Our agents are trained to assess our client’s situation and find the best discounts to ensure they aren’t overpaying. Some of the common discount categories are listed below: Good Driver Discount: If you qualify, this one is automatically added to every policy. In CA, the definition of a good driver is a person with at least 3 years of driving experience (so you have to be at least 19 years old). You can only have gotten 1 minor ticket OR 1 at-fault accident within the last 3 years, but this accident can not have caused anyone any injuries. Even if a $1 claim was made by you, anyone in your car, or anyone in the other car, it could cause this accident to be considered at fault with injury, which could in turn cause you to lose the good driver discount. You can’t have any major violation like racing, speeding over 100, hit and run or other major violations within the last 5 years. Driving under the influence, DUI or DWI, will stay on your record for 10 years and will not qualify you for the good driver discount, which would make at least a 20% difference in premium.

Good Student Discount

Mature Driver Discount

Driver Training Discount

Occupation Discount

Special license and degrees

For more discounts, please check with your agent. Please drive carefully. To avoid accidents, don’t multitask in the car. Obey traffic regulations and go to traffic school to waive tickets when possible – your wallet will thank you for driving safely.

Question 37

What happens if I'm a passenger in a friend's car and I'm injured as a result of an uninsured motorist?

Accepted Answer

If your friend has Uninsured Motorists (UM) or Underinsured Motorists (UIM) protection, you would be covered under your friend’s policy. If your friend doesn’t have UM or UIM, you would receive protection under your own UM or UIM coverage. Note: Some states specify the order in which policies can be pursued for UM/UIM coverage.

Question 38

What is a deductible?

Accepted Answer

It’s the amount of out-of-pocket expenses you must pay before an insurer will cover your costs. For example, if your auto insurance policy has a $500.00 deductible and you were in an auto accident causing $800.00 worth of damage, you are responsible for the first $500.00 (deductible) of the damage. The insurance company will pay the remaining balance, which in this example is $300.00. You may select different deductibles for collision and comprehensive coverage.

Question 39

What is not covered under my auto policy?

Accepted Answer

Wear-and-tear, freezing, mechanical breakdown, and road damage to tires by potholes are not covered by your auto insurance policy. Check your policy for other restrictions.

Question 40

What is the difference between collision and comprehensive coverage?

Accepted Answer

Comprehensive coverage pays for physical damage to your auto caused by things such as fire, theft, hail, vandalism, and animals. These events are called “perils” in your policy. Some examples of a comprehensive loss include:

Your auto is struck by debris that falls from an overpass

Your auto is damaged by a tree falling on it

Your auto is partly or totally submerged in water

Your auto is maliciously scratched

Your auto’s tires are slashed

Your auto’s windshield is cracked by a stone

Collision coverage pays for physical damage if your auto is hit by another vehicle or runs into an object. This coverage will pay for damage to your auto regardless of who causes the accident. Some examples of a collision loss include:

Your auto strikes or is struck by another auto

You hit a pedestrian, damaging your auto (the pedestrian’s injuries are covered under liability coverage)

Your auto hits debris lying in the road

Your auto strikes a tree or fence

Your auto is struck by a shopping cart

Question 41

What is Underinsured Motorists (UIM) coverage?

Accepted Answer

UIM protects you and your passengers when an accident is caused by someone who has auto insurance but is underinsured.

Question 42

Who are covered drivers under my auto insurance policy?

Accepted Answer

You, members of your family who live in your house, and anyone who uses your car with your permission are covered under your auto policy. See policy for details.

Question 43

Why do I need Uninsured Motorists (UM) coverage?

Accepted Answer

Some drivers don’t have auto insurance, even when they’re legally required to have it. If you’re involved in an accident with an uninsured driver, that driver may not be able to pay for your damages. UM coverage protects you and your passengers from injury-related damages caused by either an uninsured driver or a hit-and-run driver. In a few states, damages to your car may also be included.

Question 44

Will higher deductibles lower my auto insurance premium?

Accepted Answer

Absolutely. The higher your deductible, the lower your premium. That’s because you’re willing to pay a higher amount in the event of an accident. Always make sure that you will be financially prepared to handle a higher deductible in the event of an accident. Consult KCAL Insurance for a free auto insurance quote with various deductibles to see how they affect your premium.

Question 45

Will my insurance rates go up if I make a claim?

Accepted Answer

Adjusting insurance premiums is not an easy decision. We want to assure you that we are doing everything we can to keep your insurance costs at KCAL Insurance equitable, while providing you with quality service. If an accident or loss occurs, certain factors can result in an increase to your policy premium, including:

Determination of fault

Amount of damages paid

State regulations

Previous accident and violation (conviction) history

Type of accident or violation

Severity of accident or violation

Question 46

I own antiques and fine art. What kind of coverage would adequately protect them?

Accepted Answer

Certain valuable items, such as antiques and fine art, may have limited coverage under basic home insurance policies. To insure them properly, you should add a Scheduled Personal Property (SPP) endorsement to your home, condo, or renter’s insurance policy.

Question 47

If I have a loss, do I need to show proof of what was in my home?

Accepted Answer

You will be asked to provide a list of all items that were destroyed or damaged. MetLife Auto & Home recommends that you take the time now to make a room-by-room list of everything you own, including when you bought the items and how much they cost. If you prefer, you can videotape the contents in your home. We also suggest keeping receipts or credit card statements for higher value items, such as furniture, appliances, rugs, and expensive clothing.

Question 48

What's Condo / Townhouse Insurance Policy?

Accepted Answer

People who own and live in a condo or townhome will generally have a condo or homeowner association. The community association will typically obtain a master insurance policy that protects the building structures and cover common area liability. The insurance premium will be divided among all homeowners within the community and paid through their monthly association fees. Often, the insurance purchased by the association will only have coverage for the exterior of the home or have very limited interior coverage. A Condo / Townhome policy will fill in the gap to cover what the master policy doesn’t. Interior structures and fixtures like wall to wall carpet, dry walls, kitchen cabinets and bathroom fixtures can be covered with this type of policy. The owners’ personal belongings like clothing, furniture, and electronics are not covered by the master policy.

Question 49

What's Dwelling Fire Insurance Policy?

Accepted Answer

Many Americans invest in residential real estate to earn rental income and/or build equity through appreciation of home values. To protect your investment from disasters or legal issues, insurance policies are purchased. Dwelling Fire insurance policies are typically issued for residential homes (up to 4 units) that are rented to others or not owner occupied. This policy is issued in the owner’s name and will safeguard the structures on the property. The policy can optionally cover personal properties like furniture or appliances that belong to the landlord. Premise liability may also be included or added to the policy up to $500,000.

Question 50

What's Homeowners Insurance Policy?

Accepted Answer

Your home is not only the place where your family lives and grows, but often it’s one of your household’s largest investments or assets. Homeowners insurance offers financial protection for your family, pays for repairs and replaces damaged property. This type of policy is for residential properties that are owner occupied. Typically, this type of policy can insure a structure of up to four families/units. This is a comprehensive policy that will protect both your property and your personal/family liability.

Question 51

What's Renters Insurance Policy?

Accepted Answer

Although the home you live in is not yours, that doesn’t mean you don’t need any insurance protection. People who rent can protect their personal belongings like cameras, TVs and even jewelry by purchasing a renters policy. This policy will protect your belongings from theft, fire, wind, hail, airplanes, vehicles, etc. Renters insurance also provides the same liability protection as homeowners insurance, but this policy is typically a fraction of the cost of a homeowners insurance policy.

Question 52

What is Medicare?

Accepted Answer

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). For more information, please visit Medicare.gov

Medicare is the medical health plan designed by the US government for individuals who are 65 or older. Certain younger individuals with disabilities or End-Stage Disease may also qualify for Medicare. This plan can help pay for partial medical costs, but does not include full coverage or most long-term care costs.

Question 53

Who is qualified for Medicare?

Accepted Answer

If you are a United States citizen or a green card holder who has legally stayed in the US for more than 5 years, and fulfill any of the following requirements, you can apply for Medicare:

People who are 65 or older,

People who are younger than 65 but have received disability benefits for over 2 years due to any disability,

People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD) or Amyotrophic Lateral Sclerosis (ALS).

Question 54

What are the four different parts of Medicare? What is the difference between Medicare Parts A, B, C, and D?

Accepted Answer

Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance): Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Medicare Part C (Medicare Advantage Plans): Offered by a private company that contracts Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

Medicare Part D (Prescription Drug Coverage): Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

When you apply for Medicare at the Social Security Office, after joining Part A and Part B, you still need to purchase Part C and Part D through an insurance agency. You need to make sure you have Prescription Drug Coverage in order to avoid the liability for a lifetime penalty or the cost generated from prescription drug purchase, which will increase your economic burden.

Question 55

What is Medicare Advantage (Part C)?

Accepted Answer

Medicare Advantage Plans are comprehensive medical plans offered by private health insurance companies. Part C can provide coverage for outpatient surgery, emergency room/ambulance, primary care physician, special care and etc. The insured would only need to pay the low-amount deductible.

Part C also provides coverage for prescription drug purchases, which is also covered under Part D. Besides all the benefits mentioned above, Medicare Advantage also provides benefits for vision, dental, acupuncture, hearing aid and medical transportation, which are not covered under any other plans.

Part C can be categorized into two types: PPO and HMO

PPO: Medical cost will be taken care of by the insurance company and original Medicare. You can choose any in-network doctors for services and it provides coverage through 50 states.

HMO: The insurance company and independent practice association (IPA) have shared responsibility for your medical cost. The insurance company will pay for high cost services such as hospitalization and emergency care while IPA will pay for low cost services such as preventive care. You will need a referral from the assigned primary care physician (PCP) before you can see any other health care professionals, which has to be within 30 miles of your residence.

Question 56

Part A and B only cover 80% of the medical cost, how I can get the rest covered?

Accepted Answer

Option One: Purchase Medicare Supplement + Prescription Drug Coverage (Part D)

Medicare Supplement provides coverage for the out-of-pocket amount not covered in Part A and Part B. Part D provides coverage for costs generated from prescription drug purchases.

Option Two: Purchase Medicare Advantage (Part C)

Medicare Advantage not only provides coverage for the out-of-pocket amount not covered in Part A and Part B, but it also covers the cost generated from prescription drug purchases. Meanwhile, it also provides other medical benefits.

Question 57

How much does Medicare cost?

Accepted Answer

Hospital Insurance (Medicare Part A): If you live in the US for more than 10 years, and have paid federal Medicare tax when you were working, then you will receive free Part A coverage; if you are already 65 years old, but haven’t worked over 10 years, you have to pay a monthly premium for Part A up to $499 per month (in 2023).

Medical Insurance (Medicare Part B): In 2023, the monthly standard premium for Part B is $164.90. However, if your retirement income is over $97,000 for a single person or $194,000 for a retired couple, you have to pay a higher monthly premium for Part B as the standard request. One thing you need to pay attention to is if you don’t apply for Medicare Part B during the Initial Enrollment Period, you may need to pay higher Part B premium for joining later.

Medicare Advantage (Part C): The premium depends on which plan you enroll in.

Prescription Drug Coverage (Part D): The premium depends on which plan you enroll in.

Question 58

When can I apply for Medicare?

Accepted Answer

If you are eligible for Medicare because you are 65 years old, the Initial Enrollment Period begins three months before you turn 65, including the month of your 65th birthday, and ends three months later.

Whether you are retired or already starting to receive Social Security, you need to contact the Social Security Office three months before turning 65 years old to apply for Medicare.

Question 59

What is the result for not applying for Medicare on time?

Accepted Answer

If you don’t apply for Medicare Part B during the Initial Enrollment Period, you can still apply between January 1st and March 31st each year. The policy will be effective on the first day of the following month. However, for each 12-month period delay, your monthly premium for Part B will increase by 10%.

Besides that, you need to purchase Part C and Part D through your insurance agency. Without Prescription Drug Coverage (Part D), you will be liable for a lifetime penalty and the costs generated from prescription drug purchases will increase your economic burden.

Question 60

If my employer has provided me with group health insurance, do I still need to join Medicare?

Accepted Answer

If you are 65 and older and still covered under you or your spouse’s group health insurance, you can delay the Medicare application until you lose the group health coverage, and then apply to join Part B during Special Enrollment. There is no penalty.

Question 61

Where can I apply for Medicare?

Accepted Answer

You can apply online: https://secure.ssa.gov/iClaim/rib

Social Security Office: 800-772-1213 Mon – Fri, 8AM – 7PM

https://secure.ssa.gov/ICON/main.jsp

Office Hours:

Question 62

What are my coverage options?

Accepted Answer

Flexibility is the key to success. Whether you own a small, medium, or large business, we can tailor a business package policy that is appropriate for you and your business. Our agents are specialists specified to each department, thus, they scout for every detail to better serve your business needs by offering an array of limits and deductibles as well as enhancement options in specialty markets. Please call our toll free number (800) 681-8288 to speak with one of our representatives.

Question 63

What are the benefits of Business Owners Insurance?

Accepted Answer

Commercial insurance is designed to help protect many of the risks your business may encounter, including:

Damage or destruction to your business vehicles

Certain liability exposures resulting from the operation of your business vehicles

Damage or destruction to your office equipment or inventory

Loss of income in case you have to suspend your business temporarily due to a covered loss

Certain business related liability exposures such as wrongful entry or search, libel, slander, and even certain offenses arising out of your business’s advertising

Risks to your cargo while in transit or storage

Theft or loss of tools and equipment

Crime coverage including robbery, burglary, even employee dishonesty

Question 64

What are the benefits of Commercial Auto Insurance?

Accepted Answer

Liability Coverage: In case you’re sued as a result of an auto accident.

Collision Coverage: Helps cover physical damage to your vehicle due to collision or upset.

Comprehensive Coverage: Helps cover physical damage to your vehicle due to fire, theft and glass breakage.

Rental Reimbursement Coverage: Helps cover the cost of a replacement vehicle for a specified period of time when your vehicle is disabled due to an insured loss.

Help Center

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