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 What if I don't have health coverage in 2016?



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Long Term Care Information


Health Reform Glossary Terms


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Contact our agency for assistance in applying for the Marketplace Health Coverage.


 


MedicalINDIVIDUAL OR GROUP HEALTH

Types of Health Insurance Plans


The three most common types of health insurance plans are Health Maintenance Organizations (HMOs), Participating Provider Options (PPOs) and Consumer Directed Health Plans (CDHPs).

HMOs

An HMO is a type of health insurance plan that gives you access to certain doctors and hospitals, often called network or contracting doctors and hospitals (sometimes called "providers").

HMO basics:
  • When you sign up, you select a primary care physician (PCP) from a network of doctors.
  • Your PCP is your first point of contact for most of your basic health care needs.
  • Women can also select an OB/GYN for obstetrical and gynecological care.
  • If you need special tests or need to see a specialist, your PCP will give you a referral to see another doctor.

The bottom line:

  • HMO plans generally have lower up-front costs, or premiums, than other types of plans.
  • They usually feature low deductibles or no deductible at all. A deductible is the amount you pay out-of-pocket before your plan kicks in.
  • HMOs usually feature low copayments as well. Copayments are set amounts (usually a dollar amount or a percentage) that you pay for care. An example of a copayment is $20 for each office visit.
  • HMO plans generally provide the highest level of coverage - meaning the lowest cost for you - when you use doctors, hospitals and specialists that are in the network.
  • If you seek care outside the network, your care may not be covered at all.

PPOs

Like HMOs, PPOs often feature a network of doctors, specialists and hospitals; however, there are some key differences between the two types of plans.

PPO basics:

  • With a PPO plan, you don't have to choose a primary care physician.
  • You have the option of receiving care from doctors, hospitals and specialists in the network or outside the network, and you don't always need a referral to see a specialist.

Key features:

  • PPO plan premiums are generally higher than HMO plans, which means you'll have to pay more up front.
  • When you receive care from a doctor or hospital that is in the network, your costs tend to be lower.
  • When you receive care from a doctor or hospital outside the network your costs are likely to be higher, and, in some cases, your care may not be covered at all.
  • PPO plans usually have a deductible. So, for example, if your PPO plan has a $2000 deductible, your coverage doesn't begin until you've paid out-of-pocket for the first $2000 of your own medical expenses. Preventive care services are not subject to the deductible.

Health Reform 
 

.Special Enrollment Period qualifications could apply to you for 2016.

Medicare Supplement Insurance

Medicare Supplement Insurance (“Medigap”)

Medicare Supplement insurance is a private health insurance plan that helps pay deductibles and coinsurance that Medicare does not pay. Often referred to as “Medigap insurance,” it is different from a Medicare Advantage plan because you remain in original Medicare (Medicare Parts A and B).

Medicare Supplement Key Features

  • Medicare Supplement or Medigap plans are sold by private insurance companies.
  • The policies are standardized, which means that they are all the same, and are identified by letters (Plans A through N). The benefits of each insurance company’s Medicare Supplement plans must be the same so you can easily compare price.
  • Each plan covers one person, so you and your spouse must each purchase your own plan.
  • You must also continue to pay the standard Medicare Part B premiums in addition to your Medicare Supplement plan premium.
  • The plans are automatically renewed each year as long as you pay your premium and follow policy rules.
  • Not all types of Medicare Supplement or Medigap policies may be available in your state. Not all companies sell each plan; they are only required to offer Plan A.
  • If you need more information about policies offered where you live, contact your state insurance department or state health insurance program (SHIP).


MEDICARE ADVANTAGE

How do Medicare Advantage Plans work?

Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.

Covered services in Medicare Advantage Plans

Medicare Advantage Plans cover all Medicare services. Medicare Advantage Plans may also offer extra coverage. Learn more about what Medicare Advantage Plans cover.

Rules for Medicare Advantage Plans

Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.

However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year.

Costs for Medicare Advantage Plans

What you pay in a Medicare Advantage Plan depends on several factors. Learn about these factors and how to get cost details.

Drug coverage in Medicare Advantage Plans

You usually get prescription drug coverage (Part D) through the plan. In some types of plans that don't offer drug coverage, you can join a Medicare Prescription Drug Plan.




     Short Term Medical  & Dental Plans

  •      Short Term Medical  Plans which offer you gap coverage for those in-between times. Like when you’re a new college grad, in between employment, or waiting for new employer sponsored benefits to begin.
  •      Dental Plans which can sometimes be added to your personal health insurance plan or purchased it by itself.









     


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