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Economic Burden of Affordable Care Act

Economic Burden of Affordable Care Act

Topic: Minimizing the Economic Burden of Affordable Care Act Pending Repeal

On President Trump’s first day in office we all heard about the executive order (EO) he signed “Minimizing the Economic Burden of Affordable Care Act Pending Repeal.” Basically, to put it in plain English, what this EO did was give the departments and agencies associated with enforcing the Affordable Care Act (ACA) the authority to ensure the law is being implemented and ease the burden of the ACA during this transition to repeal and replace.

Did the Executive order repeal Obamacare?

No, the EO did not repeal any part of Obamacare or the ACA and does not directly mention any legislation or regulation that President Trump is directing to be eased, repealed, rescinded or amended. This EO just re-enforces the power that Congress, the departments and the agencies already have to move so that changes can be made quickly to ease the economic burden of affordable care act.

Current legislation

Freedom Benefit Solutions will continue to keep you updated on any other EOs, legislation or regulations as they are released. Until then, all statutes and regulations originally enacted by the ACA continue to be in place.

What about my policy?

At this time, we do not recommend making any changes to your current policy.  We do however recommend selecting a plan for 2017 as if no changes will be made by the Trump administration.  We are not certain how long the repeal and replace process will take, nor if the penalty will still be in effect during that time.  We have many different plans to choose from, and can help you decide which plan may be best to fit your needs and budget.  Call or get a FREE QUOTE today!  Open enrollment ends Jan 31, 2017.

Click here to view the executive order “Minimizing the Economic Burden of Affordable Care Act Pending Repeal.”

PPO, HMO, EPO

Obamacare 2016

Today more than ever, people need help when buying insurance.  Some say they want Obamacare, some say they don’t want Obamacare.  Here is the skinny on Obamacare.

Plan Benefits

Obamacare is not an actual plan.  Obama made the laws and it has been coined “Obamacare”, but you still get the insurance directly from the insurance companies, however if you buy it ON EXCHANGE through healthcare.gov then you may qualify for a subsidy or a reduced premium.  In addition, when you buy on the exchange you have a longer time to pay your premiums than if you buy OFF EXCHANGE.  Therefore, THAT is why a lot of the doctors are not taking Obamacare/ON EXCHANGE plans because in theory, you could use the 3 month grace period to pay your premiums and still get care during that time.  The doctors could get stuck with treating you and never getting paid by the insurance company, or getting paid 3 mos later.  THAT is why they don’t want to take it.  Problem is, most of the companies sell the same plans ON and OFF EXCHANGE so the doctors have no idea if the person has 3 mos extra to pay or not — so they are all saying we won’t take any insurance!!!  Can you see what is going on now?

The benefits of the plans are still great, the problem this year is who will take the insurance you buy.  So make sure you look up your doctor to see if they are in network or not.

Networks

This year the networks are the key to everything.  Instead of shopping benefits, you are essentially shopping networks of providers.  A lot of companies have done away with offering PPOs entirely and are only offering EPOs and HMOs.  Again, there is nothing wrong with the benefits of either of these plans, in fact the benefits of an HMO are typically better than a PPO, however you are restricted to a certain network of doctors and those doctors are not the doctors you have seen for 20+ years.  The reason for that is, on an HMO the doctors in essence get paid less each time they see a patient than if they were to file the claim through a PPO.  In addition, there is a whole lot more paperwork to keep up with when filing a claim on an HMO too.  So a lot of the doctors who have been in business for a long time, don’t want to change how they do things (with good reason).  Therefore, the result is, you have newer “hungrier” doctors on the HMO networks.  The doctors possibly fresh out of medical school or the ones still trying to build their practice.  This doesn’t make them bad doctors, again, just not the doctors you have seen for 20+ years.

Changes

So because of all the changes within the Affordable Care Act, ACA for short, a lot of doctors are getting out of the practice.  This year, you will probably have to change doctors and will have to pay more for your insurance so be prepared.  If you decide to go without insurance entirely, there is a penalty, and it did increase for 2016.  Be aware of all of your options, and it is still FREE to have an agent help you.  They are still the most knowledgeable resources available.

What is a PPO HMO POS EPO

Is it an acronym city or the abbreviations you put behind your name! Health insurance plans are categorized by a few main ways: PPO, HMO, POS, and EPO.

Depending on which plan you buy, depends on if your care is covered when you see a network provider or any doctor. In addition, you may have larger deductible or coinsurance, and/or you may have to get a referral if you want to see a provider out of network

PPO (Preferred Provider Organizations)

PPOs give you the choice of seeing providers in network or out-of-network. You pay less if you use in network providers. You’ll pay more if you want to go out of network for doctors, providers, and hospitals. You may have higher out-of-pocket costs too. If you have a PPO plan, you can visit any doctor without a referral.

POS (Point-of-Service)

POS plans let you go to both in-network and out-of-network providers. With a POS plan, you will have to choose a PCP or primary care doctor from a list of participating providers in network. Your PCP will refer you to other in network providers as needed. If you choose to go to an out-of-network provider, you’ll need a referral and you may pay higher out-of-pocket costs.

HMO (Health Maintenance Organizations)

HMO plans usually require you to seek care from in network providers who work for or contract with the HMO. An HMO generally doesn’t cover or has limited coverage if you go out-of-network except in an emergency. If you choose to see a doctor or facility that isn’t in the HMO network, you may have to pay the full cost. Like the POS plans, HMO members usually have a PCP and must get a referral to see a specialist.

EPO (Exclusive Provider Organizations)

EPOs are much like the HMO in that they generally have coverage only if you see a provider in the EPO network (except in an emergency). Health plans generally can’t require higher copayments or coinsurance if you get emergency care from an out-of-network hospital, no matter what type of plan you have. However, providers may bill you for some additional costs.

COBRA Special Enrollment Period

The Department of Health and Human Services recently announced a one time Special Enrollment Period for anyone who has COBRA continuation from Group coverage. This will allow anyone currently on COBRA to enroll in a new ACA plan until July 1st. The normal rules of only being able to enroll in a Marketplace plan when first eligible due to loss of coverage, or when COBRA was exhausted(or during the Open Enrollment), are suspended for this time period. The decision was made because many people were unaware that would no longer be able to leave COBRA coverage during the year, and enroll in an Individual policy. Prior to 2014, people used to be able to purchase Individual coverage at any time during the year, so they could leave COBRA at any time. Under the Affordable Care Act, people are no longer able to purchase Individual coverage during the year, unless they have a Special Enrollment Period. Since COBRA coverage is often very expensive, it always worthwhile to compare Individual Health Insurance prices, especially if you might qualify for a subsidy. Please give us a call at 877-740-8683, to find out if you qualify for a Special Enrollment Period.