Understanding the Insurance Available in the Marketplace
Open Enrollment Deadline | December 15th, 2017
With the open enrollment deadline coming up right around the corner, have you researched which plans work best for you or your family?
As always Prescott House can verify your insurance to help you better understand what coverage you currently have and what benefits it will provide with our program.
Meeting Deductibles & When They Reset
Deductibles vary, depending on the provider. You will see deductibles ranging from as low as zero dollars and up into the thousands of dollars range. Before your insurance begins covering all or a portion of your medical bills, they expect your out-of-pocket medical expenses to exceed the set deductible amount (minus any co-pays, other insurance coverage and expenses not typically covered by providers.)
Calendar Year Deductible
If your deductible is based on a calendar year, you will be liable for the deductible amount starting 01/01/2018. As soon as this amount is met following the New Year, insurance coverage will set in to assist in paying your medical expenses.
Contract Year Deductible
If your provider’s plan follows a contract year renewal, it will reset based on when the contract was signed. If contract was signed on June 1st, 2017, deductible will reset on May 31st, 2018.
Coverage You Will See On The Marketplace
Some areas provide different options through their Healthcare Marketplace. Highest tier(Best Coverage) is labeled as Platinum. Gold is generally still a preferred plan. With Silver and Bronze offering coverage at the lowest rates.
Acronyms below may reflect the available plans you typically see when choosing insurance coverage.
PPO
What does PPO Insurance stand for? Preferred Provider Organization
What are the benefits of having a PPO policy? Having the ability to use any Dr., clinician and medical center in or out of network. Discounted pricing is provided if visiting in-network facilities.
Who accepts a PPO Coverage? PPOs are accepted everywhere. Pricing differs between out-of-network and in-network visits.
Where can I use a PPO plan? Preferred Provider Organization plans do have contracted providers but can still be used at any Dr. office, treatment facility, ER, etc.
HMO
What does HMO Insurance stand for? Health Maintenance Organization
What are the benefits of having a HMO policy? With a focus on community, HMOs establish preventive check ups and routines.
Who accepts a HMO Coverage? Coverage is generally limited to cover Dr.s and care groups who are contracted for work with the HMO. Out-of-Network is usually denied sans Emergency situations.
Where can I use a HMO plan? Service area is essential for eligibility as HMOs usually require you to live or work within the area you are receiving care.
POS
What does POS Insurance stand for? Point of Service
What are the benefits of having a POS policy? Lower cost for Dr.’s, clinicians and medical centers in-network.
Who accepts a POS Coverage? In-network providers only.
Where can I use a POS plan? To use this plan with specialists, POS’s requires that you are referred from your primary Dr.
EPO
What does EPO Insurance stand for? Exclusive Provider Organization
What are the benefits of having a EPO policy? These policies offer sizeable reduced rates and discounted services when using this plan with the contracted parties.
Who accepts a EPO Coverage? Outside of emergency services, this plan only allows Dr.’s, clinicians and medical centers that are “in network”.
Where can I use a EPO plan? This Exclusive Provider network consists of contracted medical professionals and facilities. Be sure to check your In Network providers that are available before making appointments.
