Tag Archives: affordable healthcare act

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.

Dental Insurance Mandate

Many people underestimate the importance of good oral health. The reality is that it is so vital that the new Health Insurance Policies under the Affordable Care Act are required to provide Pediatric Dental as anEssential Health Benefit. In 2008 over 4 million children did not obtain needed dental care simply because they couldn’t afford treatment. The top 5 reasons for maintaining good oral health are:

1. To prevent oral cancer, curable if diagnosed early

2. To prevent gum disease

3. To maintain overall good physical health, heart attacks can result from poor oral hygiene

4. To keep your teeth!

5. Have a white bright smile and prevent bad breath

Often affordability is one of the biggest factors for people not getting the dental care they need. Fortunately there is a solution. With many companies now offering affordable, comprehensive Dental Insurance to Individuals. In years past, most people could only obtain good dental benefits through a Group plan. We now have multiple plans available, with innovative benefits, such as a Dental, Vision, and Hearing plan, at a price to fit any budget. Please give us a call at 877-740-8683, or visit www.freedomfreequote.com today for a free quote.

 

Individual Health Insurance Changing in Reform

We have recently received new information on how Individual Health Insurance policies will be changing under the Affordable Care Act. If you have a Grandfathered Policy, you will still be able to keep that plan, without making any changes. If you have purchased a policy since 3-23-2010, or have made policy changes since that time, however, your policy will be changing. Several carriers have made announcements on how they will handle the transition. Some carriers will require the policyholder to take action before the end of the year, in order to keep their policy through 2014. Other carriers will automatically transition those members, so that they can keep their current policy through 2014. While some people will receive a subsidy, and may be better off changing to a new Affordable Care Act plan on the Exchange for 2014, there are many people who will not receive a subsidy, and may have substantially higher premiums in 2014, if they don’t take an action. It is very important for you to review your options now, so that you are as prepared as possible for the coming changes. Just call 877-740-8683, or visit www.freedomfreequote.com , to request a review of your current policy.

Employer Mandate Delayed in Health Care Reform

The Obama administration announced late today that they are delaying the Employer Mandate until 2015. The reason stated was due to reporting requirements. As we have known all along, there were going to be changes and tweaks in implementing the Affordable Care Act. This could be a significant change. Since employers are not required to report, they will also not be responsible for the shared responsibility payments. While the Treasury Department “strongly encourages” employers to maintain or expand Group coverage, they will not be required to do so until 2015. This could drive more uninsured into the Individual Health Insurance market. If the Individual Mandate were delayed, but other aspects of Health Care Reform were not, such as Guaranteed Issue, this could have serious consequences. We have recently seen both United Health Care and Aetna withdraw from the California Individual market. No matter where you stand on Health Care Reform, with change, there are consequences. This reminds me of one of the earliest “unintended consequences” of Reform. When children could no longer be denied Health Insurance due to pre-existing conditions, many Insurance Companies were forced to either stop offering Child Only policies, or make a limited plan selection available during a limited Open Enrollment. There are more rules and regulations being released on almost a weekly basis at this point. To stay informed, be sure to visit www.freedomfreequote.com

Medigap Plan G for the Future

For years we have beleived that Plan F was “the choice” for a Medicare Supplement, or Medigap, plan. There have been several changes in recent years, though,  that have made the Plan G Medigap policy more attractive. When Modernized Medicare Supplement plans were introduced in June 2010, that made the coverage gap narrower between the Plan F and Plan G. Now, the only difference between the two plans is that with Plan G you are responsible for your Part B Deductible. In 2012, the Part B Deductible was $140, and in 2013 it is $147. It really makes sense to choose Plan G, if there is ever an annual price difference that is greater than the Part B Deductible. Another factor that is becoming more important is Guaranteed Issue. In a Guaranteed Issue situation, an unhealthy person, with pre-existing conditions, can purchase a Plan F Medicare Supplement, but would have to qualify for a Plan G. That means there are potentially more sick people, with higher claims, enrolled in the Plan F. That has caused many carriers to have steep rate increases for their Plan F policies, while keeping the Plan G premiums more stable. The Affordable Care Act also spawned a recent move to either impose cost sharing on plans that have 1st dollar coverage, like the Plan F, or to place a surcharge on these plans. While these changes haven’t happened yet, we have encouraged our current Plan F customers, to look at changing to a Plan G. If you have a current Plan F Medicare Supplement, and are in good health, you owe it to yourself to take a look at the Plan G. We consider it the wave of the future.

For more information, or a free, no obligation quote, please visit www.emedigap411.com , or call 877-740-8683, to speak to a licensed agent.