Monday, December 15, 2014

Missed the January 1st deadline. What happens now?

December 15th was the last day to enroll in the health insurance exchange to be guaranteed coverage on January 1st. You didn't enroll in time? You didn't need coverage January 1st but might sometime this year? What happens now.

If you did not enroll in time to get coverage on January 1st you are still able to get coverage through the exchange. The marketplace is "open" until February 15th. If you enroll between the 16th and end of the month, your coverage is not eligible until the second following month. So for instance, if you enroll December 16th- December 31st, coverage will not start until February 1st. If you were to enroll on January 16th, your coverage would not start until March 1st. Enrolling in Coverage between February 1st and February 15th will guarantee coverage effective March 1st.
You are able to enroll in Medicaid or CHIP (Children's Health Insurance Program) can be done at any time.

If you do not have coverage in 2015 you will be penalized. The fees are either $325 or per person for the year ($16.50 per child under 18) or 2% of your yearly household income, whichever is more.

Sometimes our situations change and we may need coverage outside of the open enrollment period. You are able to get coverage outside of the deadline, but you would need to have a qualifying life event. Qualifying events such as, getting married, adopting a baby, or losing your job and health insurance would allow you to sign up for coverage.

Having a gap in coverage doesn't necessarily mean you will be responsible for the penalty. If the gap in coverage is less than 3 months you can avoid the fine.

Having health insurance coverage is one of the most important things you can insure yourself with. If you are not offered coverage through your employer, finding a plan that fits your needs is important. The penalty might seem low, but having unforeseen medical expenses can jeopardize your financial future.

Thursday, December 4, 2014

HMO vs PPO...do you know the difference?

Here we go with the acronyms again...HMO vs PPO...let me break it down for you. It may be a short abbreviation but the differences are big. When choosing a plan through the Health Insurance Exchange, you'll find that HMO's could be a little cheaper and when you choose an on exchange plan, the choices will be HMO's, so it's important if you are shopping for insurance to know the difference.

A PPO, (Preferred Provider Organization) and an HMO, (Health Maintenance Organization) both use a network of physicians and hospitals to give you the highest quality of care. However, the main difference is how you use those networks.

In a HMO, you go through your main primary care physician for all other types of services. So you need to choose a PCP that is in your network and you will get referrals for other providers through your chosen PCP. In the case of an emergency you would not need a referral. Ideally, this is to help lower health care costs. So with a HMO you are not necessarily limited to care, you just need to get a referral first. Typically, doctors outside of your network are not covered at all.

With a PPO, you will have more flexibility. No referrals and you can see any doctors you choose, selecting from a larger list of in network providers. Even if you choose to go out of network, there are out of network benefits. You won't get the benefits of contracted rates but you are free to see out of network providers. Just be careful of balance billing by out of network providers.

So in summary, you'll have more flexibility, out of network benefits and a larger network with PPO's but could possibly have cheaper premiums with HMO's. HMO's help streamline care with the referral to trusted physicians from your own trusted physician.