Tag Archives: healthcare.gov

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.

MedicareCard

I have Medicare, do I need to go to healthcare.gov?

All of our customers on Medicare Part A & B (or C) and possibly D are asking … “How is all this Obamacare gonna affect me?”

Well, no need to worry, you don’t need to do anything to your Medicare plan because it isn’t part of the healthcare.gov site.  If you have Medicare, you are basically already covered.

No matter how you get Medicare, whether through Original Medicare with a Medicare Supplement, or through a Medicare Advantage plan, (like an HMO or PPO) you don’t have to make any changes.

If you want to shop around for a Medicare Supplement plan or Medicare Advantage plan, you will not be able to shop rates on the Marketplace (healthcare.gov) … just give us a call and we can help you with that part or go to www.eMedigap411.com

If you only have Medicare Part B, most people do not know this, but you are not considered to have minimum essential coverage.  That means you would be subject to the penalty that people who don’t have coverage may have to pay.

If you only have Medicare Part A, you are considered covered, and of course if you have Part A and Part B you are covered.

One thing has changed and that is Medicare has expanded benefits for preventive care and drug coverage.   They now have free preventive benefits, cancer screenings, and annual wellness visits.  You can also save money while in the “donut hole” with discounts on brand-name prescriptions.  (No the donut hole is not a place to eat!  It is when your total drug costs reach a certain point while you are covered under a Medicare Part D Prescription drug plan.

If you are new to Medicare, here are some things to remember:
– Medicare’s Open Enrollment Period (October 15-December 7)
– To learn more about your Medicare options visit www.eMedigap411.com

If you have any family and friends who don’t have health insurance, or if they want to see what their subsidy amount might be, tell them to call us or visit www.healthreformenrollmentcenter.com