01 Oct 2020

Understanding Health Maintenance Organizations (HMOs)

Health Insurance shoppers faced with the decision of choosing a health insurance plan usually have a variety of choices. Among the choices, you will find Health Maintenance Organization (HMO) Plan, and a Preferred Provider Organization (PPO) plan, oftentimes you also have the choice of point of sale (POS) among others.

As the cost of health care continues to rise, those seeking insurance are looking at HMOs as a reliable alternative to reduce the cost of coverage.

HMO plans have been around for close to a hundred years. According to Wikipedia, the first HMO plan is said to have been established in 1929 by the Ross-Loos Medical Group.

HMOs come in different group models, the differences may be important for you as your options vary by type of organizational structure:

Closed Panel – Under this model, also known as the “Group Model,” the Health Maintenance Organization pays a group of physicians to provide multi-specialty services to their members. Specialties include internists, OBGYNs, surgeons, and oncologists contracting exclusively with the HMO. Member care is administered at facilities owned by the group or the HMO. Patients under this plan need to use the group to have their medical expenses covered.

Staff Model – This is another example of the closed panel model with a variation. In the staff model, the HMO hires physicians, specialists and ancillary care providers and house them in buildings owned by the HMOs. They are direct employees of the HMO. Members must also use these groups if they are to have their medical expenses covered.

Open Panel Model – This is a variation of traditional health insurance. Under this model, the HMO has a list of participating physicians that a patient can go to. The insured has a wider selection of physician choices. The doctors are not obligated to treat a patient, and they can treat non-HMO patients as well. The participating doctors have their own practice, and aside from the agreement to be paid by the HMO if they provide care for a member, they are independent of the HMO.

How HMO Plans work

Health Maintenance Organizations are a form of managed health care. According to CBS News, it is the most common form of managed care. Most HMO plans have some fundamental characteristics that are uniform across providers.

Primary Care Physicians – Generally, HMOs require that you have a PCP who will coordinate all your health care needs. This is typically a family care physician, an internist or pediatrician.

The benefit of having such a close relationship with one doctor is they get to know you very well. There is an important relationship that forms between a patient and a doctor when they have worked together for an extended period of time. Oftentimes, there is more than just running tests and taking blood samples to keeping a patient healthy. It is therefore important that you feel very comfortable confiding in your main doctor.

The primary care physician usually must authorize any specialists, labs, x-rays etcetera. He is the director of your health care.

You are required to use in-network providers – Every HMO has a list of in-network doctors, specialists, labs, x-ray facilities and therapists. If the insured wants to have their medical expenses covered, they are required to use these approved providers. There are rare exceptions, and they are covered as part of the HMO policy. Examples are; true emergencies, and in the rare case in which you need a particular specialist and the HMO does not have a provider in their network. The insured is well advised to keep their HMO in the loop to make sure they don’t step outside the policy provisions.

Benefits of HMOs

There are advantages and disadvantages to HMOs. One of the biggest benefits of these plans is that they offer very comprehensive coverage at the lowest cost of practically all forms of insurance. There are typically no maximum lifetime payout limits which are customary with other forms of insurance.

Health Maintenance Organizations focus on the wellbeing of the insured. They encourage healthy living habits and encourage members to use preventive medicine. They usually provide free health screenings, offer gym membership discounts and provide members with various forms of health education.

Drawbacks of HMOs

The primary disadvantages of HMO plans are; limited choice of physicians. If you have a preferred doctor and want to go into an HMO plan, they may not have your doctor on the list. You also need to seek a referral for any specialty needs you have outside of your primary care physician. Different HMOs have levels of service that vary in turning these referrals around.

To learn more about individual health plan options, contact the experts at HealthQuoteInfo.com at 855-881-0430. Our licensed health insurance experts will be happy to answer any questions you have.

01 Oct 2020

The Difference Between Public and Private Health Insurance

The Difference Between Public and Private Health Insurance

Understanding health insurance is one of the most complicated concepts in the United States. Determining the type of coverage each individual truly needs is just one piece of the puzzle. Each company has its own nuances that may be beneficial to some while not beneficial to others. To complicate things even further, there is a difference between public insurance and private insurance. Learning the difference and understanding which is more beneficial to you and your family will help make choosing a health insurance provider a less daunting task.

The Exchange

Public health insurance is also known as the exchange. This is Healthcare.gov or each state’s individual health insurance exchange. These plans are the ones in which national companies provide through the public marketplace at seemingly lower rates, assuming the users are eligible for the government subsidies.

It is always best to start with the positive. Therefore, there are several benefits to purchasing public health care options from the exchange. First, these are government regulated, which means they must offer healthcare that meets each and every government regulation that has been defined under the Affordable Care Act. As a result, the plan will offer benefits that most people actually need.

Another amazing benefit of purchasing public health care is that it is actually affordable for lower income families. Once you go to the government website, you will be asked a series of questions. These questions include information about your family size, income, and whether your employer offers health insurance coverage. Depending on your answers, you may be eligible for subsidies that will significantly lower your out of pocket cost for the policy or even waive any fees associated with health care coverage premiums.

In contrast, these plans are often high deductible plans, meaning you will have to spend a significant amount of money out of pocket prior to seeing any real insurance benefits. Furthermore, if you do not qualify for the subsidies, you are going to find the plans quite costly for very little benefit.

Private Insurance Options

Private health care insurance is purchased anywhere except the marketplace. This means you can research insurance options and determine the best company for your needs. You then have the option to contact that insurance provider directly to purchase insurance. Other options include working with a broker who can provide you with all of your insurance options and help you decide what plans and provider is most suited for your insurance needs. There are even private insurance exchanges that allow you the option to choose a provider best suited for your needs.

While private insurance offers high deductible, lower premium plans similar to those on the marketplace, these plans are not all that is offered through these types of carriers. For higher premiums, you may be able to purchase an insurance policy that offers lower deductibles and co-pays. Furthermore, you may be able to receive additional benefits that may be unavailable under the plans within the marketplace, such as more out-of-network options.

Making the Choice

Making the choice between public and private healthcare is a personal decision. It is important to understand that under the new tax plan, penalties will no longer be issued to those individuals who do not carry insurance. That being said, if you are not covered under an employer plan, you must look at the pros and cons of health coverage through the private and public marketplace or choosing to self-insure as an alternative.

For people with children or medical concerns, health insurance is truly a necessity. If you are a low-income family who needs health insurance, it is likely more appropriate to work with a public health care policy that can be affordable, provided you are eligible for the government subsidies. Once you begin reviewing the public policies available, you can make an educated decision for the type of policy you require given your family circumstances and needs.

However, if you are within the middle to higher income brackets that would not receive a government subsidy, it is best to consider a private insurance plan. Considering that private plans are not eligible for subsidies, you must ensure you, as an individual or family, would not be eligible for subsidies under the federal marketplace. Assuming that is the situation, you would be better covered purchasing a private insurance plan that you can afford. Consider a higher premium plan with lower deductibles if that is an affordable option for your family.

To learn more about public and private health care options, contact the experts at HealthQuoteInfo.com at 855-881-0430. Our licensed health insurance experts will be happy to answer any questions you have.

29 Jun 2020

How to Enroll for Your First Health Coverage When Turning 26?

How to Enroll for Your First Health Coverage When Turning 26?

Enroll in Your Own Job-Based Plan

If your employer currently provides health insurance for its workers, the easiest way to receive coverage immediately is to sign up for that plan. However, if you have a pre-existing condition, or take medication regularly, be sure to read the fine print to fully grasp what’s covered in the plan and what is not. Even if you don’t have pre-existing conditions, it’s good practice to know what you’re signing up for! 

Speak with your human resources representative before your 26th birthday to learn the next steps. It’s important to note that if you do not enroll with your employer’s insurance, you will not qualify for a premium tax credit and other savings based on your income to buy a Marketplace plan. You will likely pay the full price. 

Enroll in your Own Marketplace Insurance Plan

If you choose to enroll in your own marketplace insurance plan, your options vary. It depends on whether the plan you’re currently on through your parents is either through the Health Insurance Marketplace or their job. 

What to Do If You’re Covered Under Your Parent’s Health Insurance Marketplace Plan

If your parent’s coverage is a health insurance marketplace plan, good news, you can still receive coverage and benefits until December 31st, even if you turn 26 mid-year! 

  • If you’re no longer your parent’s tax dependent when coverage ends: Enroll in a Marketplace plan for the next year during Open Enrollment. You’ll most likely be eligible for savings if your income qualifies and if your job does not offer healthcare coverage. Most people who apply qualify for either a subsidized Marketplace health insurance plan or Medicaid coverage.
  • If you are a tax dependent when coverage ends: You can enroll in your Marketplace plan during Open Enrollment, but will not be eligible for any subsidies. You may, however, qualify for Medicaid.

What to Do If You Are Covered by Parent’s Job-Based Plan

If you’re currently receiving coverage from your parent’s employer, you will no longer have health insurance after your 26th birthday. Have your parents check with their Human Resources specialist for the specific date your coverage ends. In this case, you will qualify for a special enrollment period to buy health insurance. 

  • If you enroll before you lose coverage: Your new Marketplace plan can start as soon as the first day of the month after you lose coverage.
  • If you enroll after you lose coverage: Your new Marketplace plan can start the first day of the month after you pick a plan.

When Does My Special Enrollment Period Start?

Your special enrollment period starts 60 days before your coverage ends and ends 60 days after. To learn more about special enrollment and how you enroll in health insurance at 26, read what to do if you missed the open enrollment period.

02 Apr 2020

COVID-19: States is Offering ACA Special Enrollment Periods

COVID-19: States is Offering ACA Special Enrollment Periods

The coronavirus outbreak has now affected over 800,000 worldwide and has claimed close to 50,000 lives, according to the World Health Organisation’s latest reports. 

As COVID-19 continues to spread, the USA is emerging as the new global epicenter. The country now has more cases than any other and the rate of new cases and deaths remains on an upward trajectory. 

The virus that threatens the lives of hundreds of thousands of Americans is quite rightly an alarming problem for the 20-something million Americans currently living without health insurance. Most troubling are the high costs of COVID-19 treatment (over $20,000 per person) – a figure too steep for most individuals without insurance to manage. 

With states on lockdown to battle the spread, millions of businesses have shut their doors and the country’s unemployment rate has subsequently taken a hit. The rise in unemployment – which early predictions suggest could impact 47 million Americans – leaves many without employer-provided coverage, joining the ranks of the already uninsured.

If you are an uninsured individual who has changed your mind about 2020 coverage or has lost access to employment provided coverage, there’s still hope. 

The open enrollment period for health insurance ended months ago on December 15th, 2019, but states who run their own health exchanges can create special enrollment periods to provide uninsured residents with another opportunity to sign up for a 2020 health plan.

Which states have reopened coverage?

In response to the number of Americans who have or may contract COVID-19, certain states have reopened ACA Insurance Enrollment. The states have taken this stance to help ease residents’ concerns and help those who have lost coverage or have decided they need coverage.

The exchanges in California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont, and Washington state have reopened under special enrollment periods. 

Deadlines for special enrollment periods

The deadline for the special enrollment periods in the 11 states and the District of Columbia are as follows:

California – June 30
Colorado – April 3
Connecticut – April 2
District of Columbia – June 15
Maryland – April 15
Massachusetts – April 25
Minnesota – April 21
Nevada – April 15
New York – April 15
Rhode Island – April 15
Vermont – April 17
Washington – April 8

Other options available

In addition to accessing private insurance from the health insurance exchange, there is also the possibility of coverage through other avenues such as Medicaid, Medicare, and Children’s Health Insurance Program.

One thing’s for sure, now isn’t the time to place bets on getting through the outbreak without health insurance. By hoping you won’t get sick, you risk putting yourself in an uncomfortable position of owing thousands of dollars. 

Get in touch with HealthQuoteInfo today to check your eligibility for special enrollment periods and other options unique to your situation. Our advisors will help find health coverage that works for you and your family. Call us today on 1-855-881-0430.

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

15 Mar 2019

3 Ways Technology is Improving Healthcare

3 Ways Technology is Improving Healthcare

 

Modern advancements in technology are changing how Americans work and spend their free-time. It’s also hugely transforming the health industry both in the offices of health practitioners and in our homes.

Electronic Health Records (EHRs)

Electronic Health Records (EHR) facilitate countless advances in medical diagnostics and treatments making it easier to share and transfer patient records. The goal of using EHR is to deliver high-quality care for all. Many systems have been connected and data can be transferred quickly. Using data from patient records can also be used to improve quality outcomes through their care management programs.  

Telemedicine / Telehealth

Telemedicine refers to methods of advancing healthcare based on telecommunications technologies. Not only is this advancement incredibly convenient, but it’s also a way for rural areas and those with limited mobility to meet virtually with their doctor. Another added benefit is the cost benefits for both providers and patients. According to the Alliance for Connected Care, telehealth services can save up to $100 per visit.

Wearable Technology & Remote Monitoring Tools

Remote monitoring tools are an incredible advancement for those who suffer from chronic illnesses or heart diseases. These products can help patients monitor their health from home saving them both time and money. Advancements in items like pacemakers also send data to health centers so they can be monitored from a distance. There are also very popular with those who want to take an active role in their health. Huffington Post projects that by 2018 130 million wearable devices will be sent to consumers.

Find out how you can better protect yourself with extended Medicare coverage by contacting the professionals of healthquoteinfo.com at 1-855-881-0430.

3 Ways Technology is Improving Healthcare