If someone needs treatment out-of-network for a pre-existing condition they either need to pay out-of-pocket, pay their out-of-network cost sharing amount, get approval from the insurer, or switch to a multi-state plan.
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
In America we don’t turn people away in emergencies, but you won’t be able to get care outside of an emergency unless you pay out-of-pocket or have a health plan.
Out-of-pocket cost sharing amounts are based on policy periods and holding a specific policy. So don’t switch health plans mid-year if you have already paid a considerable amount in.
You will want to take exemption CODE “G” for not having coverage during open enrollment. CODE “B” is for a short coverage gap of less than 3 months. CODE “G” covers you as long as you applied during open enrollment and then enrolled in a Marketplace plan.
Find out about Health Care Sharing Ministries (HCSM), and related exemptions under ObamaCare. FACT: If your Health Care Sharing Ministry qualifies then you are exempt from the fee. Members of health care sharing ministries demonstrate their exemption by using IRS Form 8965 when filing their 1040 tax return. What are Health Care Sharing Ministries (HCSM)? Health Care Sharing… Read More
Affordable Care Act Vision Coverage Vision insurance generally isn’t covered under the Affordable Care Act (ObamaCare). However, pediatric eye care is a required benefit included on all plans that qualify as minimum essential coverage under the ACA. Even though adult vision coverage isn’t a required benefit of ObamaCare, “vision health” is still an important aspect… Read More
Get the facts on the ObamaCare replacement plan by Burr, Hatch, and Upton: the Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act. Below we present a summary, some quick facts, a pros and cons chart, a complete section-by-section breakdown, and finally we compare the CARE Act proposal to ObamaCare. Keep in mind this is an older replacement… Read More
ObamaCare sign up numbers reach 10 million after a surge in Federal Marketplace enrollments. A February 2015 HHS report shows ObamaCare is working. Enrollment numbers have surpassed 10 million between the state and federal marketplaces. It also points out some other really cool and groundbreaking facts about the uninsured rate (updated with citations on March 18 2015)…. Read More
You’ve heard about vaccination and its dangers. Let’s look at the facts and myths on vaccines covered under ObamaCare at no out-of-pocket costs.
Get the facts on vaccines. Should we vaccinate our children, should I get the flu shot, what are the risks, pros, cons, and myths? We uncover the truth. FACT: The flu vaccination and other vaccinations are covered at no out-of-pocket cost on all major medical plans under the Affordable Care Act (ObamaCare). That means if you… Read More
Get the facts on low cost health insurance, how Medicaid and Marketplace subsidies can lower your costs, and how to get affordable coverage. Getting low cost health insurance is a little more complicated than just finding the right broker, picking the lowest premium plan, or general cost sharing amounts. It’s about understanding what cost assistance you… Read More
Let’s look at how ObamaCare affects immigrants and how immigration status affects Marketplace coverage, cost assistance, Medicaid, and coverage requirements. Most immigration statuses qualify people to use the Marketplace, but only lawfully present immigrants have access to cost assistance and are required to obtain coverage. Limitations apply to specific groups in regards to Marketplace coverage, Medicaid, and… Read More
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
Some say ObamaCare doesn’t do enough to control health care cost. Let’s look at how ObamaCare controls healthcare spending with cost controlling provisions. TIP: To find out what coverage under the Affordable Care Act will cost you, make sure to check out the healthcare.gov marketplace and find your cost after assistance is applied. Taxpayers are benefitting as… Read More
Alicia, 39, and Rusk, 37, have been married for 14 years, and have two sons, 11 and 7. Alicia, a former teacher, and Rusk, who owns an auto repair shop, did not have health insurance until the Health Insurance Marketplace opened last year. The 2015 premium for Rusk and Alicia is $373 a month, much… Read More
Cost-sharing in health insurance is your share of costs (copays, coinsurance, deductible, out-of-pocket maximum) for covered benefits in a policy period. Typically cost-sharing does not apply to Premiums, uncovered costs, or balance billing. TIP: In simple terms, cost-sharing describes your share of the costs vs. your insurer’s share of the cost in respect to your… Read More
ObamaCare’s Platinum Plan is a type of Metal Plan on the Health Insurance Marketplace. Platinum Plans qualify for Tax Credits and have the highest premiums. Other Metal Plans include Bronze, Silver, and Gold. Also, a Catastrophic Plan is available to young adults and to some people with hardship exemptions. Platinum plans have the highest premiums and the lowest cost-sharing. They only make… Read More
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
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
ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost-Sharing subsidies. Other Metal Plans include Bronze, Gold, and Platinum. Also, a Catastrophic Plan is available to young adults and to some people with hardship exemptions. HealthCare.Gov, or your state’s Marketplace in states that don’t… Read More
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
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
Get health insurance quotes and find out if you qualify for cost assistance from CMS approved brokers and on HealthCare.Gov. Below we will discuss the best ways to get health insurance quotes (HINT: Start at ObamaCare’s Health Insurance Marketplace sometimes called “the Marketplace” AKA HealthCare.Gov). We’ll also give you lots of helpful advice to help ensure you get… Read More
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