How Essential Health Benefits Affect Treatments for Mental Health and Substance Use Disorders

How Essential Health Benefits Affect Treatments for Mental Health and Substance Use Disorders

Unknown 3:25 PM 1

Your mental health has an impact on your physical well-being and happiness.

June 26, 2018 - By Julia Pak - 4 min read

Maintaining your mental health is just as essential to well-being and happiness as your physical health. With 1 in 5 adults living with a mental illness in the United States, this category of public health greatly impacts our society. Moreover, mental and behavioral health treatments face unique social barriers, from public stigma to lack of comprehensive resources.
In 2014, the Affordable Care Act established 10 essential health benefits, or EHBs, that every traditional health insurance plan must cover. Identified as an EHB, mental health and substance use disorder services received federal recognition, igniting a nationwide conversation about mental health. Over the past few years, accessing and affording treatment for mental illnesses has become easier for individuals seeking help.
With coverage from your plan, you can speak to a mental health provider - one step closer to leading a emotionally and physically healthy life. Click To Tweet Once you have been clinically diagnosed with a mental illness or substance use disorder, you can start to consider treatment options to manage your symptoms. Whichever course of action you and your doctor decide to pursue, you’ll want to know if your insurance provider will cover it. Fortunately, most common services with professionals are covered by your health plan.

What’s in the Mental Health and Substance Use Disorder Services Benefit?

Mental or Behavioral Health Treatments: If you’re diagnosed with a mental disorder by a doctor, your therapy and other outpatient treatment options will likely be considered “medically necessary”. This means your health plan must cover sessions with a professional.

Psychiatrists	Psychiatrists are medical doctors who are licensed to not only provide therapy with individuals but also prescribe medications if necessary. They are trained to diagnose and treat mental illnesses as well as substance use disorders.
Psychologists	Psychologists can help people with mental disorders through different forms of verbal therapy. They receive extensive training and must complete a doctoral degree in order to practice.
Mental Health    Counselors	Mental health counselors are required to receive a master’s degree to help you manage your mental health condition. They’re problem-solvers who can guide individuals through treatment.
Licensed Clinical Social Workers	Licensed social workers hold a master’s or doctoral degree in social work to offer diagnoses and treatments for mental illnesses.

• Other Therapies: Other treatments beyond conventional therapies for mental illnesses, may be encouraged by your psychologist or psychiatrist. For example, art, music, and drama therapies are all creative ways that allow individuals express their feelings. Coverage for costs of services and supplies are evaluated per case by health insurance companies.

In your search for a mental health professional, it’s important to find out whether or not they accept health insurance plans. Certain psychiatrists and psychologists may only conduct their practice with complete control over their payments, and will not accept payment through insurance companies. Check with your health insurance company for a list of in-network mental health workers to reduce costs per session.
Inpatient Services: If you are pre-approved by a physician to stay at a rehabilitation facility, your visit should be covered by your health insurance provider. However, the number of consecutive days of stay that is included may differ from state to state.

• Inpatient Rehabilitation for Mental Illnesses: Psychiatric hospitalizations and inpatient treatment programs at full-service mental facilities are a part of your health plan.
• Inpatient Rehabilitation for Substance Use Disorders: Day-treatments, inpatient detox, and residential rehabilitation for people with substance use disorders can be covered by major health insurance providers.

Substance Use Disorder Treatments: Services to help individuals living with these disorders are included in your health plan. The following treatments will likely be covered depending on your health insurance provider and state you live in: medical detox, medication for addiction maintenance, follow-up counseling, and transitional recovery services.

What’s Not in the Mental Health and Substance Use Disorder Services Benefit?

Education and Training: Your health insurance may not cover extensive education and training beyond the scope of therapy and counseling sessions. For example, many health plans do not include mental health-related vocational therapy, or resources for family members. However, with online resources at your fingertips, you can learn more about mental illnesses and substance abuse.
Custodial Care: Daily assistance from non-licensed medical personnel is not considered an essential health benefit. Reimbursement for medical care from family members or friends will also not be covered.
Private Accommodations: If you require daily long-term care, a private room, or any other personal necessities as a part of treatment, your health insurance is not required to cover these costs.

How Does This Relate to Other Essential Health Benefits?

• Psychiatric Drugs: Prescription drugs, including medications to treat mental illnesses, are a separate essential health benefit under the ACA. With the increasing popularity of pharmacological treatments, coverage from health insurance providers continues to help thousands of people every day.
• Some Preventative Screenings: Under other essential health benefits, such as preventive care, screenings for some mental health illnesses should be covered. Examples include screenings for depression, alcohol misuse, and tobacco use. Screenings are crucial in detecting illnesses at an early stage to avoid the development of more severe symptoms.

If you are seeking substance use or mental health treatment, it’s important to determine what services your health insurance provider will cover. Your provider should give you a better idea of the therapies and services that are specific to certain illnesses.

What Does “Covered” Mean?

After you see a mental health professional, you can expect to pay for the visit if he or she accepts health insurance. When your insurance provider covers medical services, including mental health treatments, you also have to contribute to the costs. This can either be in the form of a copayment or coinsurance.

Covered Just Like Any Other Service: You don’t have to worry that the costs for mental health treatments will be more than what you pay for physical health services. The Mental Health Parity and Addiction Equity Act, passed in 2008, helped close the gap for physical and mental health treatments. This law requires coverage for mental health and substance use disorder services to be comparable to physical health services.

Therefore, insurance companies have to charge nearly equal amounts whether you visit a psychologist or a medical doctor. Finances and treatment cannot be restricted for mental health services when compared to other services.

On HMO-type plans, your doctor may need to write a referral before you can see a mental health worker. On other plans, you can visit the provider directly, without prior authorization.

If you continue sessions with a therapist over an extended period of time, your health insurance can periodically reevaluate whether they are “necessary”.

Healthcare professionals can continue speaking about mental health and treatment options to reduce stigma in society. Your mental and emotional health are equally as important as your physical health. By including mental health and substance use disorder services as an essential health benefit, individuals can take the next steps in affording treatment.

Got A Health Insurance Cancellation Letter? Here’s What Happens If Your Health Plan Cancels On You

Got A Health Insurance Cancellation Letter? Here’s What Happens If Your Health Plan Cancels On You

Unknown 3:19 PM Add

A cancellation letter gives you a second chance to join a health insurance plan.

July 11, 2018 - By Hal Levy - 5 min read

You should be relieved if your health insurance plan sends you a cancellation letter! Your health insurance cancellation letter may also be called a “non-renewal notice”. According to the federal government, people who switched plans in 2017 saved an average of $500.
It’s not your fault if your health plan dumps you. You’re simply free to choose a new health plan.

Should You Be Concerned That You Lost Your Health Plan?

The Affordable Care Act generally prevents major medical insurers from canceling plans. Insurers cannot dump you because you used too much coverage, or were rude on the phone.
Individual plans close all the time. If your plan is canceled, there should be no consequences. You won’t be viewed poorly by other insurers. You won’t have to pay for your previous medical treatment (except in rare cases of fraud). However, living without any health insurance should concern you.

What Does A Health Insurance Cancellation Letter Look Like?

Any letter from an insurer that says your current health insurance plan will no longer be offered counts as a cancellation letter.
Even if your letter includes an offer to join a new plan, you were still canceled on. Once you see that your plan is being shut down, it’s important to read your letter the whole way through.
The general rule is that you should get a cancellation notice from 90 to 180 days before your current coverage ends. This is plenty of time to join a new plan.

Choosing A New Plan Once Your Health Insurance Ends

Losing your plan entitles you to apply for insurance during a “Special Enrollment Period”. This means you’re automatically allowed to join any Obamacare health insurance plan.
Consumer Reports writes that folks “have assumed they have no choice other than to accept the automatic, and usually more expensive, replacement the company selected for them. Nothing could be further from the truth.”
Other people have to wait until the short Open Enrollment Period at the end of each year to switch plans. But if your health insurance is canceled, you don’t have to wait.
When To Choose A New Plan: Mark your calendar! You can sign up for a new health insurance plan 45 days before your current coverage ends, or 60 days after your current coverage ends. That’s a total of 105 days to get a new health insurance plan.
Even if your plan hasn’t expired yet, you can sign up for new coverage in advance. This means that you don’t have to risk it without health insurance.
If you sign up for a new plan by the 15th of the month, that plan will begin on the 1st of next month. Health insurance plans usually cancel coverage on the last day of the month for this reason.
Keep Your Mail: Make sure to keep a copy of your cancellation letter. Your new insurance company may need to have proof that you qualify.
If you can’t find your cancellation letter, you can ask for a new copy. Your new plan should be able to give you a grace period to produce the letter.
Be Careful When Joining A New Plan: Health insurance companies generally must offer you the option to join one of their most similar plans if they cancel your plan.
Do not let them sign you up for a rip-off replacement plan!
Now that you’re free to choice any plan, use a comparison site like HealthCare.com to find the most appropriate and reliable coverage in your area.

Easy Health Insurance for American Indians and Alaska Natives

Easy Health Insurance for American Indians and Alaska Natives

Unknown 3:17 PM Add

Tribal members have certain advantages when accessing healthcare.

July 13, 2018 - By Julia Pak - 3 min read

According to the 2010 U.S. census, 5.2 million individuals identify as American Indians and Alaska Natives (or AI/AN). However, nearly 1 in 3 American Indians and Alaska Natives do not have health insurance. Financial and geographic barriers to adequate healthcare continue to affect the staggering difference of uninsured tribal members.
Fortunately, members of the 573 federally recognized tribes have unique benefits when it comes to health insurance coverage. Affordable Care Act plans (also called Obamacare) and Medicaid have addressed the limitations in the healthcare system for AI/AN individuals by extending protections to this population. The Indian Health Service also provides care that fits the needs of tribal members’ communities.
Access to healthcare should be a right for all individuals. By learning more about insurance plans for American Indians and Alaska Natives, you can compare and choose the best plan. Keep reading to learn about the advantages for AI/AN individuals when it comes to enrolling in health insurance.

Health Insurance Protections for American Indians and Alaska Natives

• You can enroll in health insurance at any time of the year – others have to wait until November. Forget about having to wait for Open Enrollment Period or qualifying for a Special Enrollment Period to join an Affordable Care Act plan.
• You won’t have to pay out-of-pocket costs if you have an Indian Health Care Provider. Out-of-pocket costs include deductibles, coinsurance, and copayments.
• You can pay less (or nothing) than others for out-of-pocket costs if you have an Obamacare plan, depending on your annual income.
  Tribal members who earn less than 300 percent of the federal poverty level per year won’t have to pay any out-of-pocket expenses. Click To Tweet
• You can still use services from the Indian Health Service or other Indian health programs even if you are enrolled in a private health plan. You will also be able to access medical benefits from your private plan, including essential health benefits.

Medicaid Protections for American Indians and Alaska Natives

• You won’t have to pay premiums or out-of-pocket costs under Medicaid. Under the American Recovery and Reinvestment Act of 2009, states cannot charge Medicaid premiums to individuals using Indian health systems.
• You may have an easier time qualifying for Medicaid under eligibility rules. As a member of a federally recognized tribe, you face fewer limitations when it comes to applying for Medicaid.

What is the Indian Health Service?

The Indian Health Service, also known as the IHS, provides medical services for eligible AI/AN individuals and is funded by the federal government. As an agency of the Department of Health and Human Services, the IHS promotes the health of American Indians and Alaska Natives in all aspects. They work to provide health services that uphold both cultural and physical standards for AI/AN populations. You can use IHS if you meet the following criteria:

• You are of American Indian and/or Alaska Native descent,
• You are enrolled in an AI/AN tribe or group,
• You live on tax-exempt land, or
• You actively participate in tribal affairs.

The following individuals may also qualify for IHS even if they are not AI/AN:

• Children, younger than 19-years-old, of an eligible AI/AN, or
• Spouses of an eligible AI/AN.

If you are unsure of your eligibility status, check the official guidelines for IHS eligibility here. Keep in mind that individuals whose healthcare is provided by IHS do not have to pay out-of-pocket costs for any health services or equipment.
Currently, IHS centers provide health services for 2.2 million AI/AN throughout the United States. By providing services closer to communities with tribal members, the IHS has increased health resources for many.

The ACA, American Indians, and Alaska Natives

The Affordable Care Act, otherwise known as the ACA or “Obamacare,” reformed the healthcare system in 2010. Under the ACA, individuals who do not have health insurance are required to pay a tax penalty to the federal government, also known as the individual mandate.
However, if you identify as an American Indian and/or Alaska Native, you will not be penalized for not carrying health insurance. You can be exempt from the individual mandate if you’re eligible for Indian health programs. This is sometimes called the “Indian Exemption”. Simply complete Form 8965 to apply for the Indian health coverage exemption when you file your federal income tax return.

Health Disparities for Tribal Members

Historically, American Indians and Alaska Natives have faced challenges to access quality healthcare. Compared to the national average, AI/AN communities have less exposure to public health education and resources. And though AI/AN and other population groups encounter similar diseases, AI/AN individuals are disadvantaged by limited treatment options and lack of medical centers.
With protections from Medicaid and private health insurance plans, tribal members are able to receive the care they need at reasonable costs. Access to health insurance has improved tribal engagement with health topics, such as nutrition, illness prevention, and mental health awareness. By increasing coverage for health plans, federal laws have helped American Indians and Alaska Native and continues to work on closing the gap within the healthcare system.

What to Know About Health Insurance

What to Know About Health Insurance

Unknown 3:13 PM Add

You'll want to learn more about health insurance when you buy it on your own.

September 18, 2017 - By HealthCare.com Staff - 5 min read

In the age of Obamacare, buying health insurance means finding the cheapest possible plan and filling out an application, right? Buying the right health insurance, however, may not be so simple.
Health plans under the Affordable Care Act may look the same as pre-Obamacare insurance at its core, but there are some things you should know before you decide on a plan or keep the coverage you have another year—things your state’s exchange probably won’t tell you. When open enrollment nears, re-asses your current health insurance and look at additional options. Here’s what to know about health insurance:

1. The Lowest-Pried Health Insurance Plan May Not Be Best for You

A low monthly premium may feel manageable from month to month, but it often translates into a high deductible and high out-of-pocket expenses. This may work well if you typically visit the doctor for preventive services covered by the Affordable Care Act and little to nothing else. However, if you have an ongoing medical condition, tend to be ill and need medical care several times throughout the year, or have small children who need to see the doctor frequently, choosing the plan with the lowest monthly cost may not be your savviest move.
In 2016, the average Obamacare deductible amounts for individual and family health insurance plans sold on 37 state exchanges were as follows:

• Bronze plan – $5,731 (individual) | $116101 (family)
• Silver plan – $3,117 (individual) | $6,480 (family)
• Gold plan – $1,165 (individual) | $2,535 (family)
• Platinum plan – $223 (individual) | $468 (family)

Average monthly premiums by metal plan—before any applicable subsidies—for 40-year-old individuals in the same 37 states were as follows:

• Bronze plan – $289.88
• Silver plan – $351.02
• Gold plan – $428.51
• Platinum plan – $543.68

Using the data listed above, the 40-year-old individual could pay $733.68 more per premium annually for a Silver plan and reduce his or her deductible by $2,614—that’s a 21% increase in premium for a little over 46% decrease in annual deductible. Furthermore, the cost-sharing breakdown between a Bronze plan and a Silver plan are as follows:

• Bronze – the plan pays 60 percent of covered medical expenses; the consumer pays 40 percent
• Silver – the plan pays 70 percent of covered medical expenses; the consumer pays 30 percent

Do you see how a Bronze plan might not be such a great bargain for individuals and families who visit the doctor more often than not?
As you shop for health insurance, consider the following: How often do you use medical services? Do you typically see the doctor for preventive care? What is your total budget for health insurance when factoring in premium, deductible, copays and out-of-pocket expenses? What are the deductible, copays,  and out-of-pocket cap for each plan you are considering? Now that you know about health insurance, the answers can help you determine which plan is the best fit for both your health care needs and budget.

2. A Plan’s Provider Network Is Always Changing

Just because your preferred doctor, clinic, hospital or specialist participates in your health plan’s network does not mean that will always be the case. Networks change from year to year. Some health care providers and facilities will no longer participate. When the time comes to renew your health insurance plan or select a new one, check the network and be sure you still have access to the care you’ve been receiving.
Furthermore, many insurers use narrow networks on exchange-based plans to make them more affordable; that means the providers and hospitals considered in-network may be limited. Don’t wait until you have coverage to learn you will need to drive 30 minutes to get to urgent care or that the doctor you’ve seen for many years is no longer in-network. Investigate the network before you buy. What to know about health insurance includes the medical professionals available to you.

3. Prescription Drug Formularies Change Annually

The medication you take now may not be covered next year, even if your plan currently covers it. Prescription drug formularies change from year to year. You may be forced to take a similar name brand medication or the generic version.

4. Unless You Pay, You Don’t Have Coverage

It may sound basic, but many people get their ID card, sign up to have their premiums automatically withdrawn from their bank account and then never check to see if the payments are being made. Unfortunately, there have been glitches in the enrollment systems for both state-based and federally facilitated health insurance exchanges. Some people who made their first monthly premium payment and received enrollment materials are going to use their coverage and finding out they have none. Even if you know about health insurance, you’ll be in trouble if you don’t have it.
The Wall Street Journal’s Stephanie Armour reported on July 7, 2014, that “Months after the sign-up deadline, thousands of Americans who purchased health insurance through the Affordable Care Act still don’t have coverage due to problems in enrollment systems.” The article noted that “there are no hard numbers,” and the problem has impacted a “tiny fraction” of the 8 million enrollees. However, for those who go to use their coverage, it is a big deal.

5. Unless You Qualify for a Large Subsidy, the Marketplace May Not Be Your Best Option

Health insurance plans sold away from the state-based and federally facilitated health insurance exchanges may be cheaper—and they offer the same benefits. All health insurance plans considered minimum essential coverage must adhere to the same Affordable Care Act provisions. That means essential health benefits must be included, certain preventive services must be covered at no additional cost, and applicants cannot be denied or charged more based on health history, to list a few things you’ll want to know about health insurance.
Only plans sold on state-based and federally facilitated exchanges qualify for premium tax credits and cost-sharing subsidies. However, if your income makes you ineligible for financial assistance or the credit and/or subsidy you would receive is minimal, you might consider checking rates for health insurance plans sold in the private marketplace. Again, even if the rate is comparable or even a bit more, check the network. Networks are one factor that may vary significantly from on-exchange coverage to off-exchange coverage.
As you prepare for the next open-enrollment period, spend time carefully considering the next year’s coverage. If you need help, contact a health insurance agent or broker who can answer your questions and assist you in selecting the best coverage for your situation.

Taking the Next Steps

Add the next Open Enrollment Period to your calendar, and get ready to choose the plan you’re most comfortable with!
For More Reading:

• When Is the Special Enrollment Period for Health Insurance?
• Will I Have to Pay the Obamacare Penalty for Not Having Health Insurance?

To Get Health Insurance Quotes:
Search our collection of individual health insurance plans at HealthCare.com.

What Is a High-Deductible Health Plan (HDHP)?

What Is a High-Deductible Health Plan (HDHP)?

Unknown 3:10 PM 1

HDHPs are best-suited for people who are relatively healthy and rarely get sick or go to the doctor.

 Like the name implies, if you’re covered by a high-deductible health plan you pay a smaller premium amount each month, but you must also pay thousands of dollars out-of-pocket before insurance begins to cover the cost of your medical expenses. While high-deductible health plans cost less than traditional insurance coverage on a monthly basis, HDHP coverage can also be problematic if you get sick and need to use your health insurance.

 

Key Features:

• Affordable monthly premiums;
• One (high) deductible;
• Annual exams + preventive care are covered; and
• Access to health savings accounts (HSAs).

How Does a Plan Qualify as an HDHP?

While high-deductible health plans can be described as a form of “catastrophic coverage,” they’re in their own health insurance category. The Internal Revenue Service (IRS) determines every year what counts as an HDHP and changes from year to year.
For 2017, HDHPs are those with a deductible of at least $1,300 for individuals or at least $2,600 for families. Oftentimes, though, the deductibles are much higher.
The IRS does provide a some financial protection to people enrolled in HDHPs in the form of out-of-pocket maximums. In 2017, HDHP out-of-pocket maximums were set at $6,550 for individuals and $13,100 for families under the same plan. Slight adjustments to these limits are slated for 2018, as noted in the chart below.

What’s Covered Under a High-Deductible Health Plan?

True to their name, HDHPs carry large annual deductibles that must be met by policyholders before the insurance company covers a portion of the bill; this results in very high out-of-pocket costs at the start, before insurance actually covers anything. With HDHP coverage, medical care and services (including most prescription drug costs) require you to pay out-of-pocket until you’ve met your deductible. For example, if your high-deductible health plan has a deductible of $8,000 and you find yourself with a $14,000 hospital bill, you must pay the $8,000 out-of-pocket before your insurance kicks in and helps you cover the rest of your bill.
Preventive care services are a notable exception, as HDHPs – like all plans under the ACA – are required to cover the cost of in-network preventive care, such as annual checkups, well-woman exams, and mammograms. Some HDHPs may be compatible with a health savings account (HSA). HSAs allow those enrolled in high-deductible plans to use pre-tax dollars to pay for their medical and healthcare expenses.

What Is an HSA (Health Savings Account)?

If you’re enrolled in a high-deductible health plan, you may be eligible to start a health savings account (HSA). Money in an HSA belongs to the consumer; any funds left over at the end of the year carry over into the next year.
HSAs allow people who are enrolled in an HDHP to set aside pre-tax income to pay for certain medical expenses. Money in an HSA – and the interest earned on it – isn’t taxed. Money in an HSA can be used to cover most healthcare expenses, including doctor and outpatient services, hospital and inpatient treatments, and prescription drug costs.

How Do HSAs Work?

Employers offering HSAs in conjunction with high deductible plans can contribute to the accounts on employees’ behalf; those who use HSA frequently choose to fund the accounts with regular paycheck deductions. You can also choose to manage an HSA on your own, independent from your employer. If you have an HSA and change jobs, switch insurance plans, or retire, your HSA continues to be yours. This continuity is a feature unique to HSAs. Unlike flexible savings accounts (FSAs) or some health reimbursement arrangement plans, HSA money is not governed by a “use-it-or-lose-it” arrangement.

The Benefits of Using an HSA

There are many (financial) benefits to using an HSAs:

1. As an investment tool: you can contribute to an HSA in the same way that you can contribute to an IRA to save for retirement.
2. A a nest egg: contributions to an HSA are tax-deductible and tax-free. This means that consumers who don’t need to use HSA funds for medical expenses can leverage their savings into a nest egg for later in life.
3. HSA employer contributions: some employers are willing to make HSA contributions on your behalf, matching or adding to an employee’s own contributions.

Are You Eligible for an HSA?

If your insurance policy is considered an HDHP under the IRS, then you may be eligible to contribute to an HSA. Not all high-deductible policies are HSA-eligible, though; some HDHP insurance carriers offer HSAs, some don’t.
To be HSA-compatible, an HDHP must include all expenses under one deductible. Some high-deductible plans, for example, aren’t eligible because they have a separate deductible for prescription drug costs. If you’re unsure whether your plan is HSA-eligible, ask your insurer or employer. With some plans, HSA eligibility is not immediately evident. It can be hard to figure out whether or not a plan is HSA-eligible, particularly if you’re purchasing insurance through the state exchanges.
To Qualify for a Health Savings Account (HSA):

1. You must be enrolled in an HDHP that is HSA-compatible.
2. You can’t be enrolled in Medicare.
3. You cannot be claimed as a dependent on someone else’s tax return.
4. Your insurance provider must offer HSAs.

What Should I Know About HSA-Compatibility and HDHP Plans?

• An HDHP does not guarantee that your employer offers an HSA, only that they can.
• Not all HDHPs are HSA-compatible. Being subject to a deductible over $1,300 does not make your plan HSA-compatible by default; HDHPs must be established as HSA-compatible by your insurance carrier.
• Money in an HSA continues to belong to you, even if you change jobs or retire.

HDHPs & Prescription Drug Coverage

A high-deductible health plan covers the cost of certain prescription drugs that are considered “preventative.” Drugs that aren’t considered preventative must be paid in full if you haven’t yet met your out-of-pocket deductibles.

• “Preventative” drugs must be included under your high-deductible health plan provider’s list of approved medications to be covered in full and are not subject to your deductible.
• If you take a drug that is not on your insurer’s list, you’ll need to pay for your prescription medications out-of-pocket until you meet your plan deductible.
• Whether or not a medication qualifies as “preventative” is determined by your insurance carrier, so a particular drug’s eligibility may vary from plan to plan.
• If you’re unsure whether a particular medication is considered “preventative” under your plan, call your insurance provider and ask. This information may also be detailed in the Summary Plan Description of your coverage.

If you have an HSA, you can use HSA funds to pay for your prescription drugs each month.

Is a High-Deductible Health Plan Right for Me?

It depends. HDHPs are best-suited for people who are relatively healthy and rarely get sick or go to the doctor. For those who manage chronic conditions or live on lower incomes, HDHPs are not a practical choice. At any income level, in fact, they incentivize policyholders to cut back on care they may need (this is the main reason why HDHPs are controversial). High-deductible health plan coverage can also be problematic if you have an emergency, or incur unanticipated medical costs. If you are covered by an HDHP and unexpectedly break your arm, are in a car accident, or need an appendectomy, your medical bills can add up quickly.
The most important thing to remember with a HDHP: every decision you make about your medical care counts. HDHPs require consumers to take ownership and initiative over their own care. In other words, it’s crucial for consumers to know what is and isn’t covered by your plan. Many routine health services intended to keep you well (e.g. colonoscopies, mammograms, and vaccinations) are covered at 100 percent by HDHPs. Policyholders should understand your coverage, so they know what’s free.

HDHPs Are a Good Choice If:

• You’re a healthy adult;
• You only visit your family practitioner for covered preventive services, such as annual check-ups, screening tests, or vaccines;
• You don’t take prescription medications; and/or
• You want to reduce your monthly expenses.

HDHPs Are a Less-Than-Optimal Option If:

• You live paycheck-to-paycheck and/or struggle to manage your finances;
• You have a chronic illness (e.g. diabetes, depression, asthma, multiple sclerosis, and so on) that requires long-term management;
• You frequently get sick and/or need medical care;
• You participate in activities or play a sport where injury is common; and/or
• You take multiple medications.

Taking the Next Steps

You can evaluate your health coverage and see if it’s the best option for your needs.
For More Reading:

• How to Choose Between Major Medical Insurance and a High-Deductible Health Plan
• When High Deductible Health Insurance Is Best

To Get High-Deductible Health Insurance Quotes:
Search our database of individual health insurance plans at HealthCare.com.

What’s Your Type? Understanding Different Types of Insurance Policies

What’s Your Type? Understanding Different Types of Insurance Policies

Unknown 2:59 PM 1

This outline details the pros and cons of HMOs, PPOs, EPOs, and other plan types in an effort to help consumers understand how different types of insurance policies work.

September 5, 2017 - By Javier Castillo - 4 min read

Consumers who understand the differences between common types of insurance policies, like Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), are well-positioned to make smart decisions about their healthcare. The outline below discusses how these insurance plan types differ in terms of their benefits structure and through the coverage they offer.

Health Insurance Providers Typically Offer Four Types of Plans

1. HMO Health Plans: While HMO plans are less expensive than other plan types, their provider networks are smaller, so HMOs offer less flexibility and fewer options when it comes to choosing doctors and hospitals. Under HMO plans, primary care physicians coordinate policyholders’ medical care and referrals are usually required in order to see a specialist.
2. PPO Health Plans: PPOs tend to be more expensive than HMOs, but they don’t require policyholders to get a referral before seeing a specialist. In addition, PPOs incentivize consumers to seek care within the insurer’s provider network by providing less coverage for out-of-network care.
3. EPO Health Plans: EPOs share similarities with both HMO and PPO plans. EPOs are similar to PPOs in that they don’t require referrals; however, EPOs resemble HMOs in the sense that policyholders must receive care within the insurer’s provider network.
4. POS Health Plans: POS plans are similar to both HMO and PPOs plans. Like an HMO, POS plans require members to select a primary care physician and to get referrals from that primary care physician before seeking care from specialists. However, POS plans also offer members flexibility to get out-of-network care, much like PPO plans do.

HMOs vs. PPOs: How Do These Types of Insurance Policies Compare?

HMO (“Health Maintenance Organization“)

• In an HMO healthcare plan, members choose a primary care physician (which may be referred to shorthand as a “PCP”).
• Most of your non-emergency health care services will start through that doctor. You will need a referral from your primary care physician before you can see any other health care professional, except in an emergency.
• Visits to health care professionals outside of your network typically aren’t covered by your insurance.
• HMO plans typical put more restrictions on coverage than other plan types. For example, allowing only a set number of visits, tests or treatments inside of a plan year.
• HMOs are in-general less expensive than PPOs because the primary care physician in theory helps to guide to the optimal care. However, it is less consumer-friendly to have to make decisions about your care along with a PCP. For example, if you had a skin issue, you would have to see a PCP first who would have to approve and refer you to a dermatologist.
• If there is a provider (e.g., a doctor) that you must include, it’s crucial that you check whether that provider is inside of the network before choosing an HMO plan.
• HMOs are good options for members who do not use healthcare services often.
• Final Note: HMO stands for health maintenance organization. It’s not necessary for you to understand the etymology or history of the term. It’s more important that you understand the concepts, and how HMOs differ from PPOs.

PPO (“Preferred Provider Organization”)

• PPO is another healthcare plan type that offer members with more flexibility than a HMO.
• They provide more choices to the patient in terms of where, when and how they receive care.
• You won’t need the approval of a primary care physician in order to see a specialist
• As long as you stay within the plan’s provider network (hence, the “preferred” portion of its name), you will pay the healthcare plan’s stated rates for co-pays.
• In terms of costs, PPO plans tend to have higher monthly premiums than HMO plan. They also generally have a higher deductible.
• In addition, the costs are usually significantly higher for going “out-of-network” in a PPO plan, so the recommendation would be to do sparingly.

Choosing Between Different Types of Insurance Policies: HMO vs. PPO

While the overall cost of a PPO is higher vs. an equivalent HMO, you will have more flexibility to see providers and quicker access to specialists. The rest of this page will cover each plan type in more detail, and plus some less-common plan types that you may encounter when comparing health insurance plans.

In addition to HMOs and PPOs, there are EPOs, POS, and Indemnity plans–all of which are less common types of insurance policies than HMOs and PPOs.

EPO (“Exclusive Provider Organization”)

EPOs are less common than HMOs and PPOs, and are a hybrid between PPO and HMO plans. They have some of the cost-savings of an HMO, because they require you to visit the insurance company’s in-network providers. Unlike a PPO, the insurance company does not require members to have a primary care physician, and members will not need to go through the PCP to see a specialist provider.

POS (“Point of Service”)

POS health plans are like a hybrid of two different types of insurance policies, HMOs and PPOs. Like HMOs, members are required to designate a primary care physician who will then make referrals to network specialists when needed. Depending upon the plan, services rendered by your PCP are typically not subject to a deductible and preventive care benefits are usually included. Like a PPO plan, members may receive care from out-of-network health care providers but at a greater out-of-pocket cost. Members may also be responsible for co-payments, coinsurance and an annual deductible.

To Get Health Insurance Quotes:

Search our database of individual health insurance plans at HealthCare.com.