Health coverage questions.

A fixed indemnity plan pays a set cash benefit for a covered service. People choose it for predictable benefits, a lower premium, and flexibility. It is not major medical, and it is not health insurance.

A private major medical PPO shares the cost of covered care through a PPO network. The carrier asks health questions. It is not an ACA plan.

Short-term medical is a bridge with an end date. Accident, critical illness, dental, and vision policies sit alongside a medical plan.

A licensed carrier issues the policy. The brochure lists the benefits, limits, and exclusions. That document controls, not this page.

Fixed indemnity, explained Private major medical PPO plans

No. The private plans described in these guides are not ACA Marketplace plans, sometimes called Obamacare. That includes a private major medical PPO. Private major medical PPO plans.

Need an ACA plan? We can help with that too. Estimate savings at HealthCare.gov or call 1-800-318-2596.

A fixed indemnity plan pays set cash benefits for covered services. Maternity, mental health, substance use treatment, and pediatric dental are generally outside that benefit schedule. Short-term plans work the same way on those four items.

A private major medical PPO shares the cost of covered care. What it covers is in its brochure. Private major medical PPO plans.

The brochure has the full list. If any of those four items matters to you, say so before you apply. For an ACA plan, we can help with that too.

It depends on the type of plan. A fixed indemnity plan pays a set cash benefit, so the brochure lists that benefit rather than an out-of-pocket maximum.

Some short-term and multi-year plans state a deductible and a maximum. A private major medical PPO also states a maximum. The brochure is where that number lives. Private major medical PPO plans.

A copay is an amount you pay at a visit under many traditional plans. A fixed indemnity plan pays you a set cash benefit instead. The dollar amount in the brochure is what the plan pays.

Check the provider search for the network named on the plan, then call the office to confirm.

Whether one named doctor is in one named plan is not something this page can settle.

Book a health call about a specific doctor

Private plans in these guides can usually be applied for in any month. The carrier sets the effective date. Coverage starts only when the carrier issues the policy. The day you apply is not that day.

ACA Marketplace enrollment follows a calendar. For 2027 coverage, HealthCare.gov lists open enrollment as November 1, 2026 through January 15, 2027, and December 15, 2026 for a January 1, 2027 start. Confirm the dates on HealthCare.gov. A special enrollment period can open after certain life events. HealthCare.gov decides which events count.

Many private plans look back at recent care. A condition, a prescription, or a test in that window can be limited or left out, especially at the start of the policy. How far the plan looks, and what it does with what it finds, is in the brochure.

How that rule applies to your history is not a general answer.

Book a health call

A quote uses the information on hand that day. The carrier sets the final premium when it reviews the application. It can also offer a higher rate or decline the application. Fees, if the plan has them, are separate. Seth can read a quote with you. The quote is not an approval.

Some plans add an application fee or a monthly membership fee. If Seth sends a quote, those fees are listed on it. The amounts live in the plan documents.

Yes, we can help with an ACA plan. Savings, if any, depend on household income and are estimated at HealthCare.gov or by calling 1-800-318-2596. If your income comes in higher than you estimated, you may pay some of the savings back at tax time.

Whether you qualify, and how a Marketplace plan compares with your other options, is a call. Need Medicare? We can help with that too.

Book a health call

Other options may exist. A decline is not something this page can map for you.

Book a health call

Payment is set up in the carrier application, or in the member portal after the policy is issued. Many plans use a bank draft. This website does not take card numbers or bank account numbers.

To change a draft date, use the portal or call Seth. He can point you to the right screen. He cannot change it from this page.

After the policy is issued

Check that the doctor is in the network named on your ID card, then confirm with the office. Give the front desk the insurance company name exactly as it is printed on the card. If you have two plans, give the primary card first.

On a fixed indemnity plan, the benefit amounts are the cash benefit the plan pays.

First-visit steps

An explanation of benefits, or EOB, is not a bill. It shows what the provider billed, any network reduction, what the plan paid, and what you may owe.

Do not pay a medical bill until you have the EOB for that date of service. If the balance looks wrong, call Seth before you pay it or agree to a payment plan.

How to read an EOB

Some plans include a phone or video visit, and some do not. The brochure says whether yours does.

Do not assume a visit is included because another plan you had included one.

Seth may use an assistant that is not a licensed agent. It can book a call, resend a link, check whether an application was submitted, and help if a page will not load.

It does not recommend plans, quote prices, or say what a policy covers. Those questions come to Seth.

How buying works

Yes. Life insurance is a separate conversation from the health plans on these pages.

Book a life call

Disability insurance is for people 55 and under. Disability page.