Tag Archives: health care reform

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.

June is National Safety Month-Do you have Accident Coverage?

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.

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

How to Delay the Impact of Health Care Reform

If you have group coverage, and you are a small business … listen up! We are advising our customers whose insurance renews in January 2014 to basically “hit the reset button” on their health plan in December. Why? If you push your renewal date to December instead of January, it could allow your business the chance to delay the impact of some key provisions of the affordable health care bill that go into affect Jan 2014.

The affordable healthcare act says that small business health plans will have to cover a range of required benefits. We feel this is going to drastically raise the insurance rates for companies with younger, healthier workers and possibly decrease the rates slightly for businesses with less healthy workers.

In one insurer’s documented case, they projected as high as a 78% rate up for a relatively healthy employer if they renewed in January; However, by renewing early they could limit their increase to 15% or less.

Some states are questioning this early renewal tactic to delay compliance with the reform.  Check with your agent, or give us a call. We feel, if you can save money, everything little bit helps, even if it is for a short term fix. If your state or carrier will not allow it, we can help you in another way! Give us a call 877-740-8683.