Health Insurance Frequently Asked Questions

We want you to get the most out of your health insurance. As always, feel free to contact us with any questions. 

1) What happens if my premium payment is late? If your payment is 30 days late, your policy will cancel for non-payment. You can’t reinstate it outside Open Enrollment (11/1 to 12/15).  

2) Why did my premium suddenly go up so much? If your premium increases unexpectedly during the plan year, contact us right away. This is a symptom of an issue with your application which must be corrected immediately.  

3) What do I do if my income changes? Contact us to discuss the situation. Please do not contact the Health Insurance Marketplace directly unless we advise you to do so, as there may be unintended consequences for you. 

4) What if I cannot afford the monthly premium? If your premium is unaffordable or your income drops dramatically or there is a large adjustment on your tax return, let us know as soon as possible. 

5) I’ve been referred to a new doctor. How do I know my plan will cover the office visit? Before you make any medical appointment, call your insurer to confirm that the provider is in your plan’s network.  

6) I need to change my plan or add someone to my plan. How can I do that? You cannot change the plan you are enrolled in or add people to your plan after December 15th unless one of the following events occurs: Significant drop in income, Marriage, Divorce, Birth, Adoption, or you move to another state. Contact us if one of these events occurs. You have 31 days from birth or adoption placement to add a dependent child.  

7) My child under 26 is on the plan but no longer my dependent. Is that a problem? To claim Premium Tax Credit for a child, the child must be your dependent. A young adult who is no longer your dependent would be better served to get their own plan – they may be eligible for Premium Tax Credit as a working adult with their own income.  

8) What does my plan cover? You have access to your plan’s unique Summary of Benefits and Coverage but all plans must cover a set of Essential Health Benefits https://www.coverme.gov/learn-more/marketplace-plans.  Also, certain benefits are mandated by Maine Law: https://www1.maine.gov/pfr/insurance/consumers/consumer-guides/mandated-health-insurance-benefits  and some by Federal Law: https://www.healthcare.gov/coverage/preventive-care-benefits/  

9) Does my plan cover Dental or Vision? Usually Not. Some plans may offer limited coverage for children. Some plans may cover a standard vision exam for adults and children. But a traditional standalone Vision and/or Dental plan is required to get more coverage. We can give you a proposal if you are interested.  

10) I’m now eligible for health insurance coverage through my job or my spouse’s job. What do I do? If you get offered coverage through a job, please contact us. To determine if you can keep your current plan (and the Premium Tax Credit you receive with it), we need to know how much it will cost you to enroll in the plan, and how much it will cost you to add a spouse and/or children and what the coverage is (deductible, out of pocket maximum.) 

11) I will be eligible for Medicare soon. Can I keep this plan instead? In a word, no. If you are approaching your 65th birthday, or your 25th month of eligibility for Social Security Disability Income, call us to discuss your options under Medicare. You are REQUIRED to switch to Medicare from Obamacare as soon as you are eligible to do so.  

12) I have claims or billing questions. Can I call you?  We cannot look up your claims information and we cannot take your payments nor tell you the amount that you owe or the payment due date. We recommend you contact the insurer FIRST with your questions about pending claims or bills and then call us afterwards. We will do our best to advise you.  

13) I get a lot of emails from CoverME.gov. Are they important? Your CoverME.gov account allows you to subscribe to official notes via Mail, Email and/or Text. Since we do not receive notice from CoverME.gov, we recommend you review all communications you receive from them. If you have questions, all you need to do is call, email or text us and we can look up the message in your account, read it ourselves, and advise you of the correct next step.  

14) I would like to make a formal Complaint against the insurer or Appeal a Claim Denial. How is that done? The Maine Bureau of Insurance handles Complaints and Appeals. You can file a complaint online or complete a form and mail it in, but we recommend you first review what the Bureau can and cannot do. All this information is available online at https://www1.maine.gov/pfr/insurance/consumers/health-insurance-for-individuals-and-families/complaints-appeals-external-reviews  

15) I have a friend I’d like to refer to you. How do I do that? Just have them mention your name when we ask them how they heard about Wheelers. Send new customers our way and you will receive a small token of our thanks and a chance to win some cash in our monthly Referral Rewards drawing. 

16) Can you review my other insurance coverage? Yes. We offer a full lineup of insurance solutions, and a team of experts is ready to serve you. Call us at 743-8927 or 824-2580 or visit us at http://www.wheelersinsurance.com to get started.