What Everybody Ought to Know About Health Insurance Networks

Here’s a Quick Way to Know about Health Insurance Networks:

HMO, EPO, PPO, POS, HSA they all seem just a bunch of letters, let us examine the differences.

HMO (Health Maintenance Organization). These type of Health Insurance networks are characterized by having a closed network; an insured is not allowed to see providers outside of this network, except in an emergency that it allows the member to go to the nearest emergency room. An HMO plan will require the insured to have a primary care physician to manage the care; this primary care physician must provide a referral for network specialists. Some HMO plans can also be open access, where the primary care physician referral is not needed to see a network specialist. The plan will outline the rules and if any authorization is needed on the summary of benefits. HMO plans in a good amount of scenarios have lower monthly premiums.

EPO (Exclusive Provider Organization). These types of plans do not require the insured to have a primary care doctor. Is similar to HMOs because they have a closed network and no out of network benefits, and similar to a PPOs since you do not need a referral from your primary care physician to see specialists.

PPO (Preferred Provider Organization), this network allows the insured to see providers in or out of network without a referral. A primary care physician is not needed by the plan, but it is always recommended to have a main doctor. When the insured sees a provider outside of the network, a higher deductible and coinsurance will apply. Insurance companies that offer PPO plans have Health Insurance networks that can be regional or national. These plans normally carry a higher monthly insurance premium.

POS (Point of Service), these plans are very similar to the PPOs since they allow the insured to see providers inside or outside of the network, and to the HMOs since you required to have a primary care physician.   It brings a combination of some aspects of the PPO and HMO plans. The insured’s out of pocket expenses are higher when going outside of health insurance networks. Monthly premiums for this type of plan are normally higher than the HMO plans.

HSA (Health Savings Account) plans. These plans have a high deductible and the funds deposited into the account are not subject to federal taxes, these funds can be used to pay medical expenses covered by the insurance that are subject to deductible. If the funds are not used, they roll over to the next year. But if the funds are used for non-medical expenses, is not good. The taxes will be similar to making a withdrawal from a qualified account like an IRA, subject to penalties when is an early withdrawal.

Call (888) 256-2234 for more information.

We are not providing legal or tax advice, please refer to your attorney or tax professional.

Health Insurance Network List

Health Insurance Network List

Things to Consider When Getting Individual Health Insurance in Florida

individual Health Insurance in Florida

individual Health Insurance in Florida

Health insurance can be very confusing for some.   This article will go over key aspects of individual health coverage in Florida.

If you missed the open enrollment period for the Affordable Care Act (ACA), you can obtain short term medical coverage until December 31, 2014. Short term medical will cover any accidents or illnesses that arise since the inception of the policy, subject to deductibles, coinsurance and copayments if any. Pre-existing conditions are not covered and they are not guaranteed issue plans, nor are these plans ACA complaint.   There are a limited number of insurance companies that offer this coverage.   These plans are for individuals that missed open enrollment, they are in between jobs, or will soon be on Medicare.

When outside of the open enrollment period, you are only allowed to enroll in a major medical ACA complaint coverage if you have a qualifying event and you are granted a special enrollment period. You have 60 days to enroll in a health insurance plan following the qualifying event.

Here are a few examples of qualifying events:

  • Marriage
  • Adopting a child
  • Having a baby
  • Loss of health coverage, due to job loss, divorce, etc. (voluntarily loss by not paying premiums is not considered loss of coverage)
  • A change in immigration status
  • Other exceptional circumstances

For open enrollment for 2015 plans, the proposed period is from November 15, 2014 to February 15, 2015. During this period, you can enroll in a plan directly with an insurance company of your choice or if seeking subsidy, through the Health Insurance Marketplace. There is only one lifestyle question, if you are a smoker or not. No health questions are asked, so everyone can get coverage.

Plans ACA- compliant can be HMO, PPO, EPO, POS, HSA plans. These plan differences are explained in another article.

Subsidy levels are discussed in another article as well.

For more information about individual health insurance in Florida call (888) 256-2234, to speak with one of our experts. Since we are licensed insurance professionals, we do not charge to assist you in electing coverage.