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What kind of Individual or Family Health Insurance Plans are there?
Individual and family health insurance plans are usually described as either “indemnity” or “managed-care” plans. The major differences are; Choice of health care providers, Out-of-pocket costs, and How bills are paid. Typically, indemnity plans offer a wider selection of health care providers than managed-care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill. That means that you may have to pay upfront and then obtain reimbursement from your health insurance company.
There are several different types of managed-care health insurance plans. These include HMO, PPO, and POS plans. Managed-care plans typically use health care provider networks. Health care providers within a network agree to perform services for managed-care plan patients at pre-negotiated rates and will usually submit the claim to the insurance company for you.
In general, you’ll have less paperwork and lower out-of-pocket costs with a managed-care health insurance plan, and you’ll have a broader choice of health care providers with an indemnity plan.
How does an HMO work?
Though there are many variations, HMO (Health Maintenance Organization) plans typically give members lower out-of-pocket health care expenses but also offer less flexibility in the choice of physicians or hospital than other health insurance plans. As a member of an HMO, you’ll be required to choose a primary care physician (PCP). Your PCP will take care of most of your health care needs. Before you can see a specialist, you’ll need to obtain a referral from your PCP.
With an HMO, you’ll likely have coverage for a broader range of preventive health care services than you would through another type of plan. You may not be required to pay a deductible before coverage starts and your copayments could be minimal. With an HMO plan, you typically won’t have to submit any of your own claims to the insurance company. However, keep in mind that you’ll likely have no coverage at all for services rendered by non-network providers or for services rendered without a proper referral from your PCP.
How does an Indemnity Plan work?
A traditional indemnity plan offers a great deal of freedom in choosing which doctors and hospitals to use, but will probably involve higher out-of-pocket costs and more paperwork. With an indemnity plan, you can see any doctor or specialists you like, with no referrals required. Though you may choose to get the most of your basic care from a single doctor, your insurance company will not require you to choose a primary care physician.
However, this kind of freedom can be expensive. You’ll surely be required to pay an annual deductible before the insurance company begins to pay medical bills. Once your deductible has been met, the insurance company will typically pay your claims at a set percentage of the “usual, customary, and reasonable (UCR) rate” for the service. The UCR rate is the amount that health care providers in your area typically charge for any given service.
An indemnity plan may also require that you pay up front for services and then submit a claim to the insurance company for reimbursement.
What is a Co-payment?
A copayment or “copay” is a specific charge that your health insurance plan may require that you pay for a specific medical service or supply.
For example, your health insurance plan may require a $15 copayment for an office visit or brand-name prescription drug, after which the insurance company often pays the remainder of the charges.
What is a deductible?
A deductible is a specific dollar amount that your health insurance company may require that you pay out-of-pocket each year before your health insurance plan begins to make payments for claims for certain services. Not all health insurance plans require a deductible. As a general rule (though there are many exceptions), HMO plans typically do not require a deductible, while most indemnity and PPO plans do.
What’s the difference between
in-network and an out-of-network provider?
An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates.
An out-of-network provider is one not contracted with the health insurance plan.
Typically, if you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. Though there are some exceptions, in many cases, the insurance company will either pay less or not pay anything for services you receive from out-of-network providers. As a general rule, PPO, POS, and HMO plans make use of provider networks. Indemnity plans typically do not.
Why should I use a Quote service like yours?
- Wide selection. Because we are a health insurance quote provider and not a health insurance company, we can offer plans from multiple insurance companies in your area. We offer a broad selection of health insurance companies and plans, letting you find the plan that best fits your needs.
- Best prices. Health insurance premiums are filed with and regulated by your state’s Department of Insurance. Whether you buy from one of our agents, or directly from the health insurance company, you’ll pay the same monthly premium for the same plan.
- Speedy processing. The entire application process is done online and monitored by your personal agent.
- Excellent customer care. The licensed health insurance agents and knowledgeable representatives that staff our customer care center will help you make the most of your money with professional, unbiased advice.
What You Need to Know about Obamacare: 10 Common Questions Answered
The Affordable Care Act (ACA), also known as Obamacare, is essentially a framework of federal rules around health-care coverage. Health insurance companies are now required to pay for a certain minimum amount of health care and services, and to remove caps (the maximum amount they’ll cover) on certain care. The law has set up a system for guaranteed coverage and a “Patient’s Bill of Rights,” which establishes certain protections for consumers. In late 2017, the Trump administration repealed the individual mandate, meaning that by 2019 it was no longer a requirement to buy health care coverage.
Why would health care coverage be required under Obamacare?
Here are a couple of reasons the ACA requires you to have health insurance.
When people have no health insurance and get sick or injured, they often end up in hospital emergency rooms. This kind of care costs more than ordinary doctor visits. If you can’t afford to pay, the hospital generally still has to provide some care, and someone has to pay it. This can mean increased health insurance premiums or taxes for everyone else.
Health insurance companies can keep costs down if they insure many people, and only a small percentage of their members are considered high-risk (having ongoing or expected health problems). The more people a company insures, the more it can “spread out” the risk. People with health issues may be more likely to sign up for insurance than healthy people. But if everyone has to get insurance, regardless of their health, the average amount the insurer pays out for each person’s care will likely go down — so companies can keep premiums lower.
What are the categories of health insurance?
Obamacare, as many people call the Affordable Care Act, sets a minimum amount of coverage that health insurance policies must provide. Each plan must cover at least 60% of the total average estimated costs of patient care. Under the ACA, you can choose among several insurance plan categories, called Platinum, Gold, Silver, and Bronze. The levels correspond to the different premiums and cost sharing you can expect for each insurance plan category; it isn’t related to the amount of coverage or quality of care. Platinum has the highest premiums, but the lowest average out-of-pocket costs; Bronze has the lowest premiums, but the highest average costs. For example, you can expect a Bronze plan to have higher copayments and a higher deductible than
a comparable Platinum plan. Short-term “gap” coverage can provide some health coverage for you when you don’t otherwise have an opportunity to enroll in a more complete health plan — for example, if you missed the Open Enrollment period.
How has Obamacare changed health insurance and costs?
Obamacare rules have affected everyone – insurance companies, medical providers, and individual consumers like you.
Before the ACA, people with health problems sometimes had trouble finding an insurance company that would cover them. The ACA requires not only that health insurers can’t turn you down or charge you more if you have a “pre-existing condition;” it also mandates that if you have a health insurance policy and get sick (for example, with a chronic illness such as cancer), the company cannot drop you as a member for medical reasons.
In most cases, you’re now entitled to many free preventive services, such as certain vaccinations and screenings.
Some people may have barely noticed a change; for example, if you get health coverage through your job and it covers everything Obamacare requires, things might not have changed that much for you.
Others may have seen their health insurance premiums change in 2017 (or earlier). There are many factors influencing rates; one of them may be the increased coverage some companies may need to provide in order to meet ACA standards. Other factors may include where you live, your age, whether you smoke, and what plan category you have.
Where you live can have a big effect on the size of your monthly premium. According to the Kaiser Family Foundation , a 2015 study of cities in 11 states found that in some cities, premium rates for Silver plans are lower than last year; on the other hand, some cities saw a premium hike of up to 16%.
If you’re not insured, or if you are but want to switch to a different insurance policy, you can now visit an online “marketplace” to explore your options. Visit your state health insurance website or Healthcare.gov.
What minimum health coverage does a plan have to include?
Under Obamacare, a health insurance plan has to cover at least a certain portion of your costs for these services and items
(often called “essential health benefits”):
Outpatient services
Emergency services
Hospitalization
Pregnancy, maternity, and newborn care
Mental health and substance abuse services
Prescription drugs
Rehabilitative care
Lab services
Preventive care
Pediatric services
hat recent news about Obamacare should I be aware of?
Obamacare Individual Mandate Repealed
As mentioned before, the individual mandate has been repealed.
Shorter Open Enrollment Periods
The 2018 open enrollment period ran from November 1, 2017 through December 15, 2017. It will be the same amount of time for the 2019 open enrollment period. This time frame is shorter than open enrollment periods in the past, so make sure you pay attention to dates and avoid missing your chance to get covered.
What are the top qualifying life events that triggered Special Enrollment Periods?
Loss of health coverage 49%
Permanent move 11%
Marriage or divorce 6%
Birth or adoption of a child 3%
Where can I find health insurance I can afford?
It’s important to compare plans carefully and make sure you get one that suits your health needs and your budget. We’re here to help you. Feel free to contact one of our licensed insurance agents, or just click the Find Plans button on this page.
How can I learn more about Obamacare?
We know that all the changes brought about by the ACA can be a lot to digest. You can read the eBook on your smartphone or tablet.