05 Jun 2019

Can I Change My Health Insurance Plan Mid Year?

Can I Change My Health Insurance Plan Mid Year?

So you’ve been stuck with a health insurance plan, perhaps from your employer, or from scrambling to get the best possible deal during open enrollment. But now you’re realizing that it’s not living up to its competitors.

You’re probably asking yourself, and most likely Google, “Can I change my health insurance mid-year?

You do have a few options, but they are slim so you may be stuck with your current health insurance plan until the next open enrollment period. However, you may qualify for what’s known as a “special enrollment period.”

Eligibility for special enrollment depends on if you’ve recently experienced one of the following “life events.”

Changes in household

If you or anyone in your home in the past 60 days have:

  • Gotten Married: If you choose a plan by the final day of the month, your coverage can start the beginning the following month!
  • Have had or adopted a child, or have placed a child in foster care: Coverage can on start the day of the event, even if you register in the plan later. You have 60 days to enroll.
  • Gotten divorced or have legally separated: If you still have health insurance, and have not lost it in the separation, you are not qualified for a special enrollment period.
  • Someone has died: If you’re no longer eligible for your current health plan due to someone passing that was apart of your Marketplace plan, you qualify.

Changes in residence

If one of the following moves has happened, you’ll qualify:

  • Moved to a new home in a new ZIP code or county
  • Moving to the U.S. from another country or the United States territory
  • If you’re a student, moving to/from your school
  • As a seasonal worker moving to/from the place you live and work
  • Moving to/from a shelter or transitional housing

Please note: If you want to change your health insurance mid-year, you will need to prove that you had qualifying health coverage for one or more days during the 60 days before your move. However, you don’t need to give proof if you’re moving from a foreign country or the United States territory. Relocating for medical procedures or vacation does not qualify you for the Special Enrollment Period.

Loss of health insurance

Coverage losses in the past 60 days, or future 60 days that may qualify you for a Special Enrollment Period:

  • Losing coverage from a job
  • Losing individual health coverage for a plan or policy you purchased
  • Losing qualification for Medicaid or CHIP
  • Losing eligibility for Medicare
  • Losing coverage you obtained from a family member

Other life events that can qualify you for a Special Enrollment Period:

  • Changes unqualify you for Medicaid or the Children’s Health Insurance Program (CHIP)
  • Obtaining membership in a federally acknowledged tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • Becoming newly eligible for Marketplace coverage when you become a U.S. citizen
  • Were recently released from incarceration
  • Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member

So, as you can see, there are many ways that you will be able to switch health insurance programs mid-year, but there are stringent stipulations as to when you can qualify to do so. To learn about how you can better protect yourself before the next Open Enrollment Period, give us a call at 1-844-903-3849. One of our licensed professionals will be happy to find the type of insurance coverage you need and make it easy to get your hands on competitive pricing!

05 Jun 2019

How Does a POS Plan Work?

How Does a POS Plan Work?

A Point of Service (POS) plan is similar to HMO and PPO plans that include benefit levels varying on if you get your health care in or out of your health insurance company’s network of providers. With POS health insurance, members can obtain affordable rates, flexible terms, and access a broad selection of healthcare providers and specialists.

How does a POS plan work?

POS plans essentially blends components of HMO and PPO plans for a specific type of coverage certain people look for.

They’re comparable to an HMO plan because policyholders can be obligated to assign a primary care physician who will make the needed referrals to network specialists.

Depending on the POS plan, services provided by your primary care physician are usually not subject to a deductible, and preventive care is generally included.

Like a PPO plan, policyholders can receive care from non-network providers, but with higher out-of-pocket costs. Those who are registered to a POS plan are also responsible for co-payments, coinsurance, and an annual deductible.

Who is a Good Candidate for POS Health Insurance?

While POS health insurance is not nearly as standard as HMOs or PPOs, they are right for some individuals. POS may be the right option for you if:

Already have a favorite doctor that participates in a POS network.

If your primary doctor is already in a POS health insurance network, or your a particular doctor that is in this network is one that you’re willing to work with, this is the plan for you.  POS health insurance is ideal for those whose preferred doctors are already in-network. If you are not sure if your doctor already works within a POS health insurance network, utilize your carrier’s search function. You never know, you may find that several specialists are also covered!

Do not mind going out of your network.

Like a PPO plan, members have the option to use healthcare services outside of their provider network. However, if the primary care doctor has provided a referral for an out-of-service provider, the member will be held accountable for most of the cost.

If you want the opportunity to consult with out-of-network healthcare providers, POS health insurance may be perfect for your needs. This insurance option is also an excellent option for those who use outpatient medical assistance frequently!

Want the option to see healthcare providers anywhere in America.

If you’re a snowbird or travel frequently, POS health insurance may be for you because policyholders can go out of network easily to visit any healthcare provider. Whether members frequently travel across the city or state lines, they’ll always have the freedom and access to medical coverage!

Want coverage anywhere in the event of an emergency.

You never know when an emergency will strike, and it can be especially stressful when one happens on vacation! Luckily, POS health insurance plans cover these types of medical emergencies, even if the doctor or facility you see is not within your network. If your accident turns out to not be a real crisis, POS plans may still pay for a part of the medical bills even if the policyholder went out of network.

Want an affordable, yet flexible, health insurance plan.

In the end, the most significant benefits of  POS health insurance plan is its competitive price point. While users are accountable for a portion of the statements received when visiting a doctor outside of the POS network, you may not have to pay a deductible at all if you only utilize medical care within your network. As long as you stay in your network, your co-pay will also be quite low, making POS plans highly favorable among individuals on a budget.

To see if POS plans are right for you, contact 1-844-903-4089 to speak with a licensed insurance agent. You have no commitment to buy when you call, and you’ll gain more peace of mind in deciding which healthcare plan would work the best for your needs!

05 Jun 2019

What Is An EPO Health Plan?

What Is An EPO Health Plan?

There are many benefits of finding an EPO health plan that works for you, but do you really know the ins and outs of the type of coverage?

What is an EPO Plan?

An EPO, which stands for Exclusive Provider Organization, refers to the network of healthcare providers within a health insurance plan that is committed to working with and is responsible for compensating a certain amount for your care.

When enrolled in an EPO plan, your insurer will provide cost sharing when you use a health care provider such as doctors, hospitals and imaging services that are within your network. This means that whatever type of care you accept outside of your network will not be qualified for payments through your insurance provider.

The only exemption to these restrictions is in the case of an emergency, as Insurers acknowledge that there are instances where care is vital, and insurance purchasers most likely will not have a choice as to where the care is provided. An excellent example of this situation is when an ambulance is called, and they take you to the nearest hospital.

There are also guidelines that have been set by Obama’s Affordable Care Act, that come into play with EPO plans. Insurance groups are required by law to handle out of network emergency care in the same way as in-network care.

For example, if you need critical medical attention within an emergency room, your plan has to provide you with the same cost-sharing structure for both in-network and out-of-network assistance.

What Are the Differences Between an EPO Plan and an HMO Plan?

In a way, EPO and HMO plans are quite similar. Like an EPO, Health Management Organization (HMO) plans also limit clients to an existing set of providers. However, under an HMO, the policyholder has to choose a primary care doctor that is their first point of contact for all of the care they receive.

This means that if you would like to visit with a specialist or have any type of aid, you need to get a referral from your primary physician. Those with an EPO plan have the freedom to see specialists without referrals.

This right, however, comes with its own set of compromises. Because EPO policyholders are allowed to choose their own specialists and hospitals to receive care, they need to make sure that they are within the network of providers listed within their plan.

The price of out of network care is not available for any cost sharing or out of pocket maximums given by your EPO insurer. One situation many users face is that they will begin a medical service, such as surgery in an in-network hospital, but one of the doctors involved in the pre/during/post care is not in the network.

What Is Pre-Authorization Within An EPO Plan?

The other compromise is a type of cost-saving requirement used by insurance companies called pre-authorization. While you will be able to utilize the care of specialists and service providers, your insurance company can require you to get consent before they compensate you for their part of the medical procedure. This is a common practice for high-cost services such as operations, MRIs and prescriptions.  

Know that it is your responsibility to request this type of approval before receiving any kind of care. If you don’t, you can be on the hook for the cost!

Now that you know a little more about EPO health plans contact our team of qualified Insurance professionals to find the policy that best suits your needs. Call us today at 1-844-903-3838.

 

04 Jun 2019

Inpatient vs Outpatient Coverage

Inpatient vs Outpatient Coverage

When looking for proper health care plans for your needs, you may have wondered what the difference between inpatient and outpatient care was and how it would concern you as a patient or insurance policyholder. For one, you’ll need to know how the two terms refer to the way your healthcare assistance is being provided to you.

What is Inpatient Care?

What is Outpatient Care?

What is the Difference between Inpatient vs Outpatient Care

Inpatient vs. Outpatient Rehab

How Much Does Inpatient Care Cost?

What is Inpatient Care?

Simply put, inpatient care refers to any type of medical service that a person needs to be admitted to the hospital to receive. Health insurance plans consider inpatient care as a stay due to severe illness or trauma that needs attention for at least one or more nights at the hospital. Policies typically require you to be formally admitted for it to be considered “inpatient care,” which means a doctor has to write a note to admit you. So, for example, if you were in the emergency room and were asked to stay overnight for medical observation, you will not be viewed as an inpatient in the insurer’s eyes.

Though you shouldn’t be discouraged – over half of all inpatient hospital admissions come from the emergency room and health insurance plans have some form of coverage that will help with emergency room vs. inpatient facility care costs. Case in point, some policies have copays for the services received in the emergency room waived if the health insurance policyholder is admitted to the hospital for further care.

Another important thing to note is that inpatient care has two components: the facility fee and those costs associated with the surgeon or physician. Copays for inpatient services are commonly on a per stay or per day basis.

outpatient care

What is Outpatient Care?

Outpatient care is medical assistance that does not need an extended stay at a hospital. This can include services such as checkups, visits to clinics or more complex procedures like same day surgery. There are also many other outpatient care services available, such as rehab therapies and mental health services. Because it is less involved and does not need around the clock medical care, it tends to be less expensive.

Outpatient care is mostly broken down into what type of care you receive; for example,  Primary Care Physician, Specialist, or Mental Health programs would all have different costs. It will then describe your share of cost within that type of procedure.

Outpatient care also has two components: the facility fee and those costs associated with the surgeon or physician. Copays for inpatient services are commonly on a per stay or per day basis.

outpatient care

What is the Difference between Inpatient vs Outpatient Care

Now that you know the primary differences between the two types of care, here’s the reason why it is essential for you as a policyholder.

As you now know, outpatient and inpatient care are determined by a doctor who writes an order to confirm patients in-hospital supervision. This has a significant impact on how much a health insurance policyholder will pay after receiving their medical care.

Most of the time, the doctor’s choice between inpatient and outpatient care comes down to how intense medical care will be and is not a choice you can help decide.

Those who are admitted as inpatients will typically have more severe conditions that need around the clock care and monitoring from medical staff. Because of this, the cost of inpatient care is naturally higher due to the number of medical professionals needed to take care of you. These costs are then incurred by both the insurance company and the policyholder.

Though there are a few exemptions where patients have a choice in whether their care is administered inside or outside of a hospital. Some surgeries may allow you to choose between inpatient vs. outpatient, though it’s rare. For example, some types of knee surgery can be handled either or and can be helpful for those who have time constraints such as work days or not enough coverage to pay for the additional price of overnight facility care.

Inpatient and Outpatient Rehab

Policyholders can choose inpatient or outpatient care when it comes to rehabilitation. This applies to physical therapy as well as drug recovery. This is not restricted to only hospitals; it can include specialized physical rehab facilities too.

All types of rehab services have a separate breakdown of benefits and coverage that vary between insurance plans. The categorization deals with the cost-sharing involved with the services along with the different copays and coinsurances, both inpatient and outpatient rehab has. This is a significant difference to discuss with your family as policyholders who need this type of care as plans with copays can opt to charge on a per admission/stay basis or a per day basis. This could have a major effect on your finances, so be sure you read the small print carefully!

Like other forms of outpatient care, rehab normally to has much cheaper copays since these instances are similar to checkups. Copays and coinsurance for outpatient rehab are like those that you would find for a visit to a primary care physician or a specialist. This cost is roughly around $10-$50 per visit depending on your healthcare plan. On the flip side, inpatient rehab costs can majorly differ depending on the facility and health insurance plan.

How Much Does Inpatient Care Cost?

To give you an idea of how costly inpatient care tends to be for policyholders, here is a breakdown of inpatient costs per day at hospitals in states across America in 2017.

Location State/Local Government Hospitals Non-Profit Hospitals For-Profit Hospitals
United States $2,129 $2,574 $1,996
Alabama $1,455 $1,723 $1,621
Alaska $1,874 $3,042 $3,280
Arizona $2,209 $2,812 $2,225
Arkansas $2,032 $1,751 $1,619
California $3,217 $3,800 $2,255
Colorado $2,263 $3,319 $2,781
Connecticut $3,979 $2,655 N/A
Delaware N/A $3,039 $1,707
District of Columbia N/A $3,166 $2,433
Florida $2,079 $2,358 $1,681
Georgia $917 $2,005 $1,861
Hawaii $1,049 $2,706 N/A
Idaho $1,662 $4,208 $2,434
Illinois $2,725 $2,557 $1,649
Indiana $1,671 $2,777 $2,500
Iowa $1,547 $1,564 $1,558
Kansas $1,609 $1,872 $1,997
Kentucky $1,966 $1,954 $1,882
Louisiana $1,828 $1,981 $2,024
Maine $1,585 $2,396 $1,055
Maryland N/A $2,759 $1,207
Massachusetts $1,870 $3,221 $1,881
Michigan $1,224 $2,383 $2,227
Minnesota $1,482 $2,518 $1,771
Mississippi $1,239 $1,365 $1,762
Missouri $1,686 $2,452 $1,963
Montana $52 $1,627 $2,614
Nebraska $906 $2,148 $3,031
Nevada $2,357 $2,194 $1,794
New Hampshire N/A $2,654 $2,059
New Jersey N/A $2,717 $1,826
New Mexico $2,617 $2,782 $2,330
New York $2,775 $2,719 N/A
North Carolina $2,056 $2,157 $1,620
North Dakota N/A $1,780 $4,701
Ohio $2,884 $2,736 $2,391
Oklahoma $1,324 $2,034 $2,262
Oregon $4,062 $3,546 $2,731
Pennsylvania $787 $2,448 $1,937
Rhode Island N/A $2,843 $2,028
South Carolina N/A $2,159 $1,729
South Dakota $442 $1,519 $3,956
Tennessee $1,537 $2,193 $1,836
Texas $2,926 $2,675 $2,078
Utah $3,038 $3,291 $2,478
Vermont N/A $2,440 N/A
Virginia $2,994 $1,888 $1,895
Washington $3,312 $3,540 $2,451
West Virginia $2,461 $1,965 $1,362
Wisconsin $2,778 $2,490 $2,830
Wyoming $1,269 $2,225 $2,219

Via: KFF.org

02 Apr 2019

7 Things to Look for When Signing up for Health Insurance

7 Things to Look for When Signing up for Health Insurance

In 2017, 28.5 million Americans did not have health insurance. People who are uninsured often avoid going to the doctor, so they do not have to pay high health care costs. Avoid that problem by browsing through policies and selecting a health insurance option.

Check the premium

Insurance companies charge a fixed monthly rate for policies. This is called the premium. Premium credits are available based on income through the Health Insurance Marketplace, but not everyone is eligible for a credit. Check the premium to make sure it is affordable.

Look at the deductible

The deductible refers to the amount the insured must pay before the insurance company starts paying. Some insurance policies require that the full deductible is met before the company covers any expenses, while others cover some expenses before the deductible is reached. For example, some policies cover annual exams and other preventative care before the deductible is met. Read the fine print to avoid high out-of-pocket costs.

Consider the co-pay

Insurance companies require that people pay a co-pay for various services. People are expected to pay the co-pay at the time of receiving services, and the amount paid does not go toward the deductible. Choosing a policy with a high co-pay can make it difficult to get health care services.

Check the maximum out-of-pocket cost

Insurance policies have a maximum out-of-pocket cost. This is the most that people will have to pay out of their own pockets for co-pays, coinsurance, and deductibles over the course of the year. Once the maximum out-of-pocket cost is met, the insured does not pay any additional money out of pocket. Consider the maximum out-of-pocket cost when selecting an insurance policy.

See which doctors are available

Most people already have doctors before switching insurance plans. It is important to see which doctors are covered in the network before buying a plan. Otherwise, the insured might have to switch doctors after changing insurance plans.

Check how much coverage is available for the health insurance policy

The amount of coverage is also important. Some policies cover extra services such as acupuncture and weight loss programs, while others only cover the bare minimum. People need to choose a policy that covers everything they need to limit out-of-pocket expenses.

See if you qualify for Medicaid

Some people want to know how to sign up for free health insurance. Free and low-cost health insurance is available through Medicaid, but people must qualify to receive coverage. Eligibility depends on the state of residence, family size, and income. Those interested should fill out the online form to see if they qualify.

 

How to Sign up for Health Insurance

Now that you know what to look for, you have one more question. You are likely wondering, “where can I sign up for the best health insurance for my family and me?” It is easy to sign up for health insurance with healthquoteinfo! Call 1-855-614-5057 to speak to a licensed insurance agent today!

02 Apr 2019

How to Eat Healthier Without Sacrificing Sugar

How to Eat Healthier Without Sacrificing Sugar

The average American eats approximately 42.5 teaspoons of sugar each day. Sugar is high in calories and can lead to obesity, heart disease, type 2 diabetes, and even some forms of cancers. With so many health risks associated with sugar, some believe the only solution is to cut the sweet stuff out entirely, but that is not necessary. People can eat a healthy diet without sacrificing sugar.

The Problem With Sugar-Free Diets

People on sugar-free diets do not eat table sugar, sweeteners such as maple syrup and honey, condiments, refined flours, and some fruits. Soft drinks are also off the table, and many diets restrict dairy products. This type of regimen creates a dangerous diet mentality that is difficult to maintain over the long-term.

Such a restrictive diet can also impact the brain. The brain might think the person is starving, and if that happens, it will force the body to store fat, so it can access it as needed.

Also, the body releases stress hormones when dieting. This can also lead to increased fat storage, especially in the abdominal area.

Dieting can also impact mental health. Those dieting feel stressed and anxious, and can even become depressed due to all the physical and mental changes. Many of these people end up with orthorexia. This is a preoccupation with healthy eating. People who suffer from orthorexia obsess over the foods they eat, and it can eventually lead to an eating disorder.

What About Sugar Alternatives?

Some people feel they can avoid the diet mentality by using sugar alternatives instead of eating sugar. They make foods that include rice malt syrup, dates, and other expensive alternatives with the belief that they are living a healthier lifestyle.

These items still contain sugar, and the sugar has as many calories as added sugar in snack foods. That means these sugar alternatives do not have any health benefits and can lead to weight gain because people are less likely to watch how much of the items they consume.

The Solution

The solution is actually quite simple. Eat a diet that is full of healthy foods, such as beans, legumes, plants, whole grains, and fruit. While fruit contains sugar, it also has vitamins and minerals that keep people healthy.

Also, when indulging in a sugary snack, eat it mindfully. Turn off the TV, put down the smartphone and focus on every bite. This allows people to maximize pleasure, so they don’t want another sugary snack in an hour or two!

By eating a healthy diet and indulging from time to time, people end up eating less sugar without feeling deprived.

Stay Healthy

Eating a wholesome diet is an important first step to living a healthy life. People also need to go to the doctor at least once a year to stay healthy, and that is much easier to accomplish with health insurance. Speak to a licensed health insurance agent by calling 1-855-614-5057 or compare policies online.