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Frequently Asked Questions

We Understand Insurance So
You Don’t Have To

Below, we made a list of frequent questions and their answers for easy understanding.

Do you offer service outside of the state?

Yes! We offer out-of-state assistance as well. Our physical office is in Taylors, SC but OnGuard insurance is here to help residents of North Carolina, Tennessee, Georgia, Texas and more! Let us be OnGuard for your insurance.

Why are your services free?

Our services are $0 out of your pocket, our agency's assistance is covered by your carrier and is included in your monthly insurance plan even if it is $0! By not going through an agency, you are not using all the benefits your carrier offers you. Do not navigate it alone, let us help!

Do you offer extra benefits?

We offer dental, vision and life insurance.
We work with you to find the plan that best fits your needs
Also, we help in the area of Medicare.

What is Obamacare?

Obamacare, also known as the “Affordable care act” is not a government issued insurance plan, it is a tax credit that you are automatically qualified for if you are a citizen, resident or person with a work permit who is filing taxes. The credit can only be used to purchase insurance from private insurance companies such as Blue Cross Blue Shield, Aetna, United, Ambetter, Cigna.

Is Obamacare (ACA) considered government assistance?

Obamacare is a healthcare system reform, rather than an assistance program. The tax credit you received is according to your personal and family information. It is used solely to pay, partly or entirely, for private insurance plans and reduce the costs. The ACA aims to enhance access and affordability.

Do I have to report it on my taxes?

Yes! Anyone that gets enrolled will have to claim the tax credit in the taxes, so you need to report it to your accountant. The Marketplace sends Form 1095-A in the mail before tax season where it details exactly how much tax credit you received each month. Then, the person that is filing the taxes must complete Form 8962. After that, you may have to pay something back or receive extra credit for miscalculating your final income.

Who qualifies for Obamacare?

If you are a US citizen, a resident or have a work permit and file your taxes, then you qualify to receive a tax credit to pay for your insurance.

What is the biggest concern with Obamacare?

You need to guard your information and only work with a reputable agent you trust. All someone needs to get into your account is your name and date of birth.
There are many fraudulent marketers claiming to sell health insurance and offering a visa card with up to $600.00 per month. Sometimes they add extra insurance coverage and mislead you to believe it is all one package. Take your time to ask good questions.

What should I do if a get a call from someone who says they work with the Marketplace

If you are contacted by someone claiming to represent the Marketplace, it is crucial to confirm their identity before disclosing any personal details. Politely request their full name, department, and contact information, then verify their credentials independently by reaching out to the Marketplace using trusted contact details from their official website or documents. Refrain from sharing sensitive information unless you are confident about the caller's legitimacy.

Why is the cost of the insurance so cheap?

The cost of insurance is made cheaper due to the ACA, which provides subsidies to help people afford it. These subsidies, tailored for those with lower incomes, come in two main forms:

Premium Tax Credits: These reduce monthly insurance bills for eligible individuals and families who purchase coverage through the Health Insurance Marketplace. The credit amount is based on household income and local insurance rates.
Cost-Sharing Reductions: These decrease out-of-pocket expenses such as deductibles and copayments for eligible individuals and families with lower incomes. These reductions are specific to certain Marketplace plans, with the amount of assistance varying based on income.

What are the dangers of not using a qualified insurance agent to enroll in Obamacare?

Marketplace representatives are limited in what they can share about insurance plans. They can’t discuss key details to help you find the right fit for your needs. Only qualified agents can explain the pros and cons of plans, detail co-insurance and deductibles, and help you understand your network and benefits.

Enrolling through the Marketplace is complicated, with potential for mistakes during identity verification and subsidy acquisition. You may not receive all the necessary information to choose the best coverage.

Once enrolled, maintaining your coverage is crucial. A RAND study found that 5.9 million people lost their subsidies and coverage due to misunderstandings. OnGuard Insurance can guide you through the enrollment process and help resolve any issues with claims.

Using an agent has no additional cost, as we’re paid by the carriers. We offer free services, answer your questions, and ensure you understand the best plans in your network.

According to the Kaiser Family Foundation, about 25% of U.S. adults ages 18-64 faced difficulties paying medical bills in the past year. Being uninsured can result in overwhelming out-of-pocket costs in emergencies

What will it cost me if I do get enrolled in ObamaCare?

The Premium – the cost to have the insurance

The premium for an individual could start as low as $0 a month, depending on age and yearly income, and be as much as the base cost for the plan.
The premium for a family could start as low as $40 a month, depending on age, household size and yearly income and also be as much as the base cost for the plan.

The Plan – the cost to use the insurance

The structure of the plan (deductible, co-pays, co-insurance) varies with the details of the plan. All insurance plans under ObamaCare have an annual cap that limits the total exposure for the year and all plans also cover prescription drugs and preventive services.

How Do I Resolve an Inconsistency?

The Marketplace may request documents to verify your information if there is a data mismatch with the original information you provide. The following is a list of acceptable documents you can provide to us that we will submit to the Marketplace.

Documents to verify U.S. citizenship

U.S. passport
Certificate of Naturalization (N-550/N-570)
Certificate of Citizenship (N-560/N-561)
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Documents to verify immigration status
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Reentry Permit (I-327)
Permanent Resident Card, “Green Card” (I-551)
Refugee Travel Document (I-571)
Machine Readable Immigrant Visa (with temporary I-551 language)
Temporary I-551 Stamp (on Passport or I-94/I-94A)
Foreign passport
Arrival/Departure Record (I-94/I-94A)
Arrival/Departure Record in foreign passport (I-94)
Certificate of Eligibility for Nonimmigrant Student Status (I-20)
Certificate of Eligibility for Exchange Visitor Status (DS-2019)
Employment Authorization Card (I-766)
Notice of Action (I-797)
Certification from U.S. Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR)
Document indicating withholding of removal (or withholding of deportation)
Administrative order staying removal issued by the Department of Homeland Security
Document indicating a member of a federally-recognized Indian tribe or American Indian born in Canada
Office of Refugee Resettlement (ORR) eligibility letter (if under 18)
Resident of American Samoa Card
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Documents to verify income
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S. Individual Income Tax Return (Form 1040)
Wages and tax statement (W-2)
Pay stub
Letter from employer
Cost of living adjustment letter and other benefit verification notices
Lease agreement
Copy of a check paid to the household member
Bank or investment fund statement
Document or letter from Social Security Administration (SSA)
Form SSA 1099 Social Security benefits statement
Self-employment ledger
Letter from government agency for unemployment benefits.

How Does my Health Insurance Work?

Let’s explore the costs for your health insurance and how you would calculate them.
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‍Premium: This is the amount that you pay for coverage.
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‍Deductible: The initial amount that you pay out of pocket. Like any other type of insurance, the deductible can range in amount depending on how your plan is structured. Generally, the higher the deductible the lower the premiums.
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‍Co-insurance: The percentage of covered expenses paid by the medical plan. The co-insurance amount is per family per calendar year. For example, in a co-insurance arrangement, there can be an 80/20 split between the insured and the insurance carrier in which the insured pays 20% of the cost of care up to the deductible, but below the out-of-pocket limit set forth by the policy. This is typically associated with coverage provided by a Preferred Provider Organization.
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‍Co-payment: Sometimes referred to as a “co-pay”, this is a set cap amount that you will pay each time you receive medical services. This is typically associated with coverage through a Health Maintenance Organization. For example, every time you visit your doctor you may have to pay $20 as a co-payment. Under ObamaCare these payments now contribute toward out-of-pocket policy maximums. The co-payment and the coinsurance are not the same thing.
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‍Max Out-of-Pocket: The cumulative dollar amount of covered expenses in excess of the deductible after which the coinsurance payment stops and the insurance carrier pays 100% of covered expenses. The purpose of the stop-loss limit is to limit the out-of-pocket costs for the insured individual. At this point, all you will have to pay is your premiums.

What’s important to remember for out-of-pocket expenses is that not all expenses go toward meeting the out-of-pocket max. Premiums do not apply to the out-of-pocket expense maximum but your deductible, copays and coinsurance do apply toward this amount.

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