Do I Lose My Cost Sharing I Paid When Switching Plans?
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In general, all private plans have adopted the calendar year as a policy period. This makes switching plans easy in regards to cost sharing.
Self-Employed Health Insurance
ObamaCare and Health Insurance for the Self-Employed The Affordable Care Act (ObamaCare) has some important implications for how the self-employed go about obtaining, maintaining, and paying for health coverage. If you’re self-employed, most of the healthcare provisions in the ACA apply to you. Let’s take a look at how you’re affected by ObamaCare, how you can reduce the cost of coverage, and how… Read More
What Do I Do When Health Provider Doesn’t Honor Contract?
I have joined one of the Health Care Insurance Group. As a member they gave me a Members Kit, which has the Exclusive provider Organization Contract. In that contract under Section 6.1.8.Screening for Prostrate Cancer; it states that the Insurance Company covers an Annual standard Diagnostic Examination not subjected to Co-payments or Deductibles when provided Participating… Read More
What are Health Insurance Networks?
How Health Insurance Networks Work With Health Insurance The general types of networks are HMOs and PPOs. A given provider will then either be “in-network” or “out-of-network” for a given plan. You and your insurer save money by using “in-network providers.” You’ll almost always have different cost-sharing when you use a provider “out-of-network,” so you’ll… Read More
Self Employed Premiums Unaffordable
My husband and I have not been helped but hurt and our details are below. But before I get into our details want to say that middle income people who do not qualify for subsidies, especially those who do not have health coverage via an employer (e.g. self employed or those who work for employers… Read More
Gold Plan
ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and generous cost-sharing. Other Metal Plans include Bronze, Silver, and Platinum. Also, a Catastrophic Plan is available to young adults and to some people with hardship exemptions. Gold plans mean higher premiums, less Tax Credits, but much… Read More
Bronze Plan
ObamaCare’s Bronze Plan is a type of Metal Plan on the Health Insurance Marketplace. Bronze Plans qualify for Tax Credits and have low premiums. Other Metal Plans include Silver, Gold, and Platinum. Also a Catastrophic Plan is available to young adults and to some people with hardship exemptions. All plans offer basic benefits and minimum cost-sharing, Bronze Plans tend… Read More
Health Plan Types: HMO or PPO?
Understanding the difference between HMO Health Maintenance Organization and PPO Preferred Provider Organization health plan types helps you compare plans to get the right coverage for you and your family. You can learn about the less common EPO Exclusive Provider Organization plans here. Under ObamaCare most plans are either HMOs or PPOs. Knowing which one is… Read More
Summary of Benefits and Coverage (SBC)
Your health plan’s Summary of Benefits and Coverage (SBC) is a summary of what your plan covers in terms of benefits and cost sharing, and explanations of how everything works. We suggest opening up a Summary of Benefits and Coverage sheet as you follow along. The Summary of Benefits and Coverage PDF can be found… Read More
Tips for Getting the Best Health Plan
Here is a quick list of tips for getting the best health plan. No matter how you shop, this list will ensure you don’t over or under-buy health insurance. NOTE: Finding the best health plan for you and your family depends on your family size, income, needs, region, and more. The best plan for one… Read More
CommonWealth: State Trends in Employer Coverage
State Trends in the Cost of Employer Health Insurance Coverage, 2003–2013 The new January 2015 Commonwealth Fund healthcare report shows the ACA is the only thing curbing health insurance costs, which are rising faster than income. The report is long, but the point is short, employer-sponsored health Insurance costs (particularly premiums and deductibles) have been rising… Read More
Factors that Affect Health Insurance Costs
Let’s take a look at factors that affect health insurance costs for premiums and cost sharing under ObamaCare, including Marketplace subsidies and Medicaid. ObamaCare helps ensure fair health insurance premiums (Sec. 2701), helps curb premium growth, and provides Tax Credits to lower premium costs. The ACA also includes measures to reduce out-of-pocket spending and curb national… Read More
The Medicaid Gap
Obamacare gives the Insurance companies carte blanche for EXTORTION (already a MAJOR problem–people would have insurance IF they could afford it.) Husband and I were both professionals, RN and Chemical Engineer. At age 60, due to military cutbacks he lost his job. You don’t get another job at 60 in this economy. So we were… Read More
Health Insurance Coinsurance
What is Health Insurance Coinsurance? In health insurance, coinsurance is your share of costs of the allowed amount for a covered service after you reach your deductible. Coinsurance is different from a copay which is a fixed dollar amount for services and is not typically dependent on meeting your deductible. How does Coinsurance Work? Each service or drug that is subject… Read More
Health Insurance Copay (Copayment)
What is a Health Insurance Copay? In health insurance a copay (copayment) is a fixed amount you pay for covered services, typically when you get the service. Copays differ from coinsurance (the percentage you pay for covered services, usually after reaching your deductible). Each plan treats copays and coinsurance differently, so it’s important to understand if… Read More
Health Insurance Deductible
What is a Health Insurance Deductible? Your health insurance deductible is the amount you have to pay out-of-pocket for covered services before your insurance begins to pay. It doesn’t include premiums or costs that aren’t covered by your plan. Once you meet your deductible, your plan will pay its share of your coinsurance. TIP: Your maximum deductible… Read More
Health Insurance Premium
What is a Health Insurance Premium? Your health insurance premium is the amount paid to an insurer, typically per month, for a health plan. Tax Credits are available to lower monthly premiums through the Health Insurance Marketplace. If you have coverage through work, your employer typically pays part of your premium. Let’s look a little more… Read More
Only Sign Up For ObamaCare at Trusted Sites
I have health insurance which keeps going up. They blame the increases on Obama Care. So I went online six months ago to apply for Oboma Care to see what the rates would be. I went throught the whole process and when I hit “submit”; it said I couldn’t apply till the end of the… Read More
Cost Sharing Reduction Subsidies (CSR)
How Do Cost Sharing Reduction Subsidies Work? ObamaCare’s Cost Sharing Reduction Subsidies (CSR) lower out-of-pocket costs, based on income, for Silver plans bought on the Health Insurance Marketplace. Along with Premium Tax Credits, ObamaCare’s Cost Sharing Reduction subsidies lower what you pay for out-of-pocket costs like deductibles, copays, and coinsurance, making health insurance coverage more… Read More
Out-of-pocket Maximum Limits on Health Plans
Out-of-Pocket Maximums Under the Affordable Care Act The ACA limits out-of-pocket maximums, the max amount of costs for covered services you’ll pay out-of-pocket in a policy period on your health plan. For 2023, your out-of-pocket maximum can be no more than $9,100 for an individual plan and $18,200 for a family plan before marketplace subsidies…. Read More
Health Savings Account (HSA)
What is a Health Savings Account? A Health Savings Account (HSA) is a tax-advantaged medical savings account you can contribute to and draw money from for certain medical expenses tax-free. HSAs can be used for out-of-pocket medical, dental, and vision. HSAs can’t be used to pay health insurance premiums. HSA’s can only be used with… Read More
Catastrophic Health Plans
If you are under 30 or obtained a “hardship exemption” you qualify for a high deductible, low premium, catastrophic plan. Catastrophic health plans are the cheapest plan you can get that counts as minimum essential coverage. Catastrophic plans can be good for those who want cheap, barebones care. Catastrophic plans tend to trade a low… Read More
How to Compare Health Plans
Learn how to compare health plans to get the best deals on health insurance and health care. Compare your health needs with your plans costs and coverage, to find an affordable plan with benefits that are designed to cover you. No matter how you shop, and boy are there a lot of different options under… Read More
How Does Health Insurance Work?
How does health insurance work? You pay a monthly premium and your share of annual out-of-pocket costs, and your insurer pays it’s share of covered costs. The concept is simple, but getting that perfect health plan takes some brain power and elbow grease. By taking the time to master and internalize the content of this page,… Read More
Actuarial Value
What is Actuarial Value? Actuarial value is average total of costs for covered benefits covered by a health plan. Let’s look at how ObamaCare’s metal plan actuarial values work and how actuarial value applies to all plans in general. FACT: Actuarial Value (AV) in regards to health insurance was created by the Affordable Care Act to rank ObamaCare’s… Read More