Your Insurance Questions, Answered Directly

An HMO (Health Maintenance Organization) requires you to choose a primary care doctor and get referrals to see specialists — it typically costs less per month but limits you to a specific network. A PPO (Preferred Provider Organization) lets you see any doctor without a referral and offers more flexibility, usually at a higher monthly premium (the amount you pay each month for coverage).

Your eligibility for a federal subsidy — formally called the Premium Tax Credit — depends on your household income relative to the Federal Poverty Level. If your income falls between 100% and 400% of the FPL, you likely qualify for help reducing your monthly premium. April can calculate your estimated subsidy before you choose a plan, so you know exactly what you'll pay.

Yes, if you experience a qualifying life event. Losing job-based coverage, getting married, having a baby, moving to a new state, or turning 26 and aging off a parent's plan all trigger a Special Enrollment Period — usually a 60-day window. April can confirm your eligibility and get you enrolled before that window closes.

Under the Affordable Care Act, children can remain on a parent's health insurance plan until age 26, regardless of whether they live at home, are in school, or are married. At 26, they must find their own individual coverage. April can help them transition smoothly before that deadline — at no cost.

When you lose job-based coverage, your family qualifies for a Special Enrollment Period — typically 60 days — to enroll in a new plan through the marketplace or directly with a carrier. COBRA (Consolidated Omnibus Budget Reconciliation Act) lets you continue your existing plan temporarily, but it's often expensive. April can compare your options and find the most cost-effective path forward.

Term life insurance covers you for a set period — 10, 20, or 30 years — and pays a benefit if you die during that term. It's generally less expensive per month. Whole life insurance never expires as long as premiums are paid and builds cash value over time. The right choice depends on what you need the policy to accomplish.

Not always. Many carriers offer simplified issue or guaranteed issue policies that skip the medical exam entirely, though these often come with lower coverage limits or higher premiums. Whether an exam is required depends on the coverage amount, your age, and the carrier's underwriting rules. April can identify which carriers are likely to approve you without one.

Your Initial Enrollment Period starts three months before you turn 65 and ends three months after your birth month — a seven-month window. Missing it can trigger late enrollment penalties that raise your Part B premium (the cost of outpatient medical coverage) permanently. If you're still working with employer coverage at 65, different rules apply. April can walk you through your specific timing.

Medicare Advantage (Part C) replaces Original Medicare with a private plan that often includes dental, vision, and prescription coverage — usually with lower premiums but network restrictions. Medicare Supplement (also called Medigap) works alongside Original Medicare to cover costs like deductibles and co-insurance (your share of costs after Medicare pays). The right fit depends on how often you use healthcare and which doctors you see.

Standard health insurance plans — whether purchased through an employer or the marketplace — typically do not include dental or vision coverage for adults. Preventive dental cleanings and routine eye exams are generally out-of-pocket expenses without a separate supplemental plan. April can find a standalone dental or vision policy that fills that gap quickly.

Accident insurance pays a cash benefit directly to you — not to a hospital or provider — when you're injured in a covered accident. That cash can cover your deductible (the amount you pay before insurance kicks in), co-pays, transportation, or any other out-of-pocket expense your primary health plan doesn't cover. It pays regardless of what other insurance you have.

Most critical illness policies pay a lump-sum benefit upon diagnosis of conditions including cancer, heart attack, stroke, major organ failure, and coronary artery disease. Exact covered conditions vary by carrier and policy. The lump sum is paid directly to you and can be used however you need — medical bills, lost income, mortgage payments, or daily living expenses during treatment.

A formulary is the list of prescription drugs a specific plan covers, organized into cost tiers. Tier 1 drugs — usually generics — cost the least out of pocket. Specialty medications often sit in Tier 4 or 5, where your cost share is much higher. If your medications land in a high tier, switching to a plan with a better formulary match can save hundreds of dollars per year.

Yes. If you have individual or family health insurance, prescription coverage is typically included in your plan as a benefit. But if your current plan has a high-tier placement for your medications, April can look at plans with formularies that better match your specific prescriptions — potentially lowering your total annual drug cost significantly.

Insurance Girl is compensated directly by the insurance carrier when you enroll in a plan — not by you. This is standard practice for licensed independent insurance agents. Your premium (monthly cost) is identical whether you enroll through April or directly with the carrier. Working with April costs you nothing and gives you access to someone who compares every available option on your behalf.

Insurance Girl is licensed nationwide, family, and business clients nationwide. April Palmer operates from Haslet, TX, and holds active licenses across the United States. If you're unsure whether she's licensed in your state, reach out directly — she can confirm in minutes.