We received a call this week from a mom that was concerned about her child being uninsured. She had been seeing the recent news reports about the EV-D68 virus that has recently affected thousands of children across several US states. It is a rare and non-treatable virus that has resulted in hundreds of hospital stays, ER visits, and ICU confinements. While her child did not qualify for a Special Enrollment Period, we were able to assist her in getting the child covered on a Short Term insurance policy that started the next day. While Short Term insurance doesn’t cover pre-existing conditions, or avoid the ACA tax penalty, it does provide coverage for a new diagnosis during the term of coverage. While having health insurance doesn’t keep your child from getting sick, it does provide peace of mind in knowing that you won’t be stuck with tens of thousands of dollars in medical bills. If you or someone you know needs coverage, call 877-740-8683, to see if you qualify for a Special Enrollment Period, or Short Term coverage. This is also a good time to remind everyone to get their flu shot early this year. Flu shots are covered as preventive care at no out of pocket expense under most new ACA health insurance.
We get asked all the time, what is the main difference between an HMO vs PPO. Well, let’s see if we can help answer this for everyone.
HMO in short stands for Health Maintenance Organizations and PPO is short for Participating Provider Options. An HMO is a type of health insurance plan that gives you access to certain doctors and hospitals, often called network or contracting doctors and hospitals (sometimes called “providers”). HMO basics: When you sign up, you select a primary care physician (PCP) from a network of doctors. Your PCP is your first point of contact for most of your basic health care needs. Women can also select an OB/GYN for obstetrical and gynecological care. If you need special tests or need to see a specialist, your PCP will give you a referral to see another doctor. Because HMOs generally have smaller networks, and because you have to have a referral to see a specialist, HMOs generally have lower monthly rates than other types of plans. They usually feature low deductibles or no deductible at all. Remember a deductible is the amount you pay out-of-pocket before your plan kicks in. HMOs usually feature low copayments as well. Copayments are those set amounts (usually a dollar amount or a percentage) that you pay when you receive care at the doctors office or clinic. HMOs normally have the highest level of coverage – for the lowest cost – as long as you use doctors, hospitals and specialists in network. If go out of network, you may not have coverage at all.
PPOs have a network of doctors, specialists and hospitals just like an HMO; however, there are some key differences between the two. With a PPO plan, you don’t have to choose a primary care physician. You can see any doctor, hospital or specialist in the network or outside the network, and you generally don’t need a referral to see a specialist. Now because there is more freedom on who you can see, the PPOs monthly costs are generally higher than HMO plans. When you see a doctor or hospital in network, your out of pocket costs are lower, but when you go out of network your will pay a little more, or you could have to pay for it all. PPO plans generally have a deductible just like the HMO. So, for example, if your PPO plan has a $500 deductible, your coverage doesn’t begin until you’ve paid out-of-pocket for the first $500 of your own medical expenses. Preventive care services are not subject to the deductible.
What do I Choose?
As far as which one is the best choice, they each have advantages and disadvantages and a number of factors come into play. First of all, if you have to go with price, then the HMO will be the lowest price, however you have to know you will typically have less doctors in network than a PPO, you will have to select a Primary Care Physician (PCP) and only see them, and that PCP will have to refer you anytime you need to see a specialist. If you do choose an HMO, make sure the doctor you “like” to see is at least in network. There are no guarantees that your doctor will stay in network the whole year however, so if you choose an HMO, you must be able to be flexible.
In our opinion, PPOs are the way to go of course if you can afford the monthly cost. You have freedom to choose your doctor, don’t have to worry about referrals, and if you don’t like a doctor you saw, you can just see another doctor in network and not have to change PCPs. It is simple and less likely of having an out of network claim.
Summer is coming, and you may need Short Term or Travel Insurance. Many people aren’t aware that they very limited ,or often no benefits, under their Individual or Group Health Insurance if they travel outside the US. We offer many affordable options that cover medical treatment, with additional features like emergency medical evacuation, political evacuation, and extreme sports. We have also recently helped several families that needed Short Term Insurance in the US. This has happened when children had to have proof of Insurance for things like Summer Camp. While the children didn’t qualify for a Special Enrollment Period for traditional Health Insurance, they were able to get the Short Term proof of coverage as soon as the next day, and that was enough to get them into camp. If you or someone you know may need Short Term or Travel Insurance this Summer, just call 877-740-8683, or visit www.freedomfreequote.com , to get a free quote today.
The National Safety Council says the annual cost of injuries in the US is $753 billion. This includes medical costs, lost wages, and damages. Each year 1 in 8 people will receive medical care due to a non-fatal injury, and accidents are the cause of 33% of all ER visits. Workers comp does a good job of covering accidents at work, but 70% of accidents occur outside the workplace. While most people have Health Insurance, we have found that one of the biggest gaps in both Group and Individual policies, even with the new Health Care Reform, is the ER deductible and co-pay. You can obtain an affordable Accident Policy that helps with these costs for as little as 50 cents a day. Give us a call at 877-740-8683, or visit www.freedomfreequote.com , for a free quote today.
While the Open Enrollment for Health Insurance has ended for 2014, there are still situations where an person can qualify for a Special Enrollment Period. If you have an Individual Health Insurance Policy that has a non-calendar year Renewal this year, you may qualify for a Special Enrollment Period, or SEP. This could occur if you have a Grandfathered or non-Grandfathered transitional policy. If you receive a renewal notice from your Insurer, please give us a call at 877-740-8683, to discuss your options and find out if it is in your best interest to shop for a new policy. This SEP is in addition to the COBRA Special Enrollment Period , relating to Group Health Insurance, that will last until July 1st. There are also the regular Qualifying Life Events that will trigger an SEP. The Qualifying Life Events, or QLE’s, can include such things as gaining a dependent, through birth, marriage or adoption. If you lose Minimum Essential Coverage, through no fault of your own, this can also qualify for an SEP. This could result from a loss of a job, reduction in hours, divorce, or a permanent move. There are complex deadlines surrounding the triggering events. While most SEP’s have a 60 day day window, there are some with only 30 days. If you thing you might qualify for an SEP, please call 877-740-8683, or visit www.healthreformenrollmentcenter.com , to speak to a licensed Insurance Agent for a person evaluation of your situation. If you can’t qualify for an SEP, there are still options available for Short Term Insurance, and the 2015 Open Enrollment will start November 15th.