Tag Archives: health coverage

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.

April 30 2015 Special Tax Enrollment Deadline

April 30 Deadline Montgomery Tx Special Tax Enrollment

April 30th is the Deadline if you need health insurance coverage in Montgomery Texas.  This deadline is because of a Special Tax Enrollment Period Extension for Coverage by CMS and IRS.

CMS announced that Eligible consumers have until April 30 to enroll in coverage, using this special enrollment period (SEP).  This special tax enrollment period is designed to allow  those individuals and families who were unaware or didn’t understand the implications of this new requirement the opportunity to get covered for the remainder of the year and avoid additional fees for 2015.

For those people who are eligible, CMS will provide consumers with an opportunity to purchase health insurance coverage from March 15 to April 30. If consumers do not purchase coverage for 2015 during this special tax enrollment period, they may have to pay a fee when they file their 2015 income taxes.

Those eligible for this special tax enrollment period live in states with a Federally-facilitated Marketplace and:

  • Currently are not enrolled in coverage through the FFM for 2015
  • Attest that when they filed their 2014 tax return they paid the fee for not having health coverage in 2014, and
  • Attest that they first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment (February 15, 2015) in connection with preparing their 2014 taxes.

The special tax enrollment period will begin on March 15, 2015 and end at 11:59 pm E.S.T. on April 30, 2015. If a consumer enrolls in coverage before the 15th of the month, coverage will be effective on the first day of the following month.

This year’s tax season is the first time individuals and families will be asked to provide basic information regarding their health coverage on their tax returns. Individuals who could not afford coverage or met other conditions may be eligible to receive an exemption for 2014.

Most taxpayers,  will only need to check a box when they file their taxes to indicate that they had health coverage in 2014 through their employer.  Other forms of “minimum essential coverage” are Medicare, Medicaid, veterans care or other qualified health coverage like individual coverage.  About one-quarter of the taxpayers or 10% – 20% will take different steps. It is expected that those taxpayers were uninsured for all or part of 2014 and will qualify for an exemption from the requirement to have coverage.   A small fraction, CMS estimates 2% – 4% of those will pay a fee because they made a choice to not obtain coverage and are not eligible for an exemption.

If you do not qualify for an exemption, but went without coverage for 2014 click here to see what your estimated fee would be.

If you need coverage and you are not in Montgomery Texas  click here.