Tag Archives: healthcare open enrollment

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.

2015 Texas healthcare open enrollment dates

Texas Healthcare Open Enrollment Dates

Texas are you ready?  It is almost that time of year again, the healthcare Open Enrollment period.  Since the Affordable Health Care Act (ACA) was passed, how you buy health insurance has changed and got lot of people confused.  The open enrollment period for the health insurance is the only time when you can apply for a new policy.  Because of this small window, we have provided some key dates so you don’t miss out on these important deadlines.

Texas Healthcare Open Enrollment 4 Key Dates:

November 15, 2014 — Open Enrollment begins.

You can apply for a new plan at this time, keep your old plan or change your coverage.

December 15, 2014 — Enroll by the 15th for January 1 coverage.

If you want new coverage that begins on January 1, 2015, you have until December 15th to make your choice.  If your plan is changing or you want to change plans, enroll by the 15th to avoid a lapse in coverage.

December 31, 2014 — Coverage ends for 2014 plans.

If you didn’t enroll by December 31st, you can still enroll up until February 15th, however your coverage may not start on January 1st.

February 15, 2015 — Last day to apply for 2015 coverage

If you do not apply by February 15, 2015 — before end of Open Enrollment, you won’t have another opportunity to enroll in an ACA plan unless you qualify for a special enrollment period.  This may result in penalties.

DON’T FORGET:

You do  have to apply during the healthcare open enrollment but you DO NOT have to apply on the marketplace or at healthcare.gov.  You CAN use an agent/agency to help you with the process and it doesn’t cost any extra to get advice from an agent.

You can always call us at 877-740-8683.

We are PPACA certified and premier agents with BCBS, Humana, Cigna, Aetna, Assurant, UHC, and many others.  We are also licensed in 28 states.