(For Groups And Those Under The Age Of 65 Who Do Not Qualify For Medicare)
Understanding The Affordable Care Act (ACA)
Commonly Known As Obamacare
Before researching plans, it first needs to be determined whether you will be purchasing through the Federally Facilitated Marketplace (FFM), the State Exchange, or through the Private Marketplace.
Which Type Of Plan is Right for You?
Generally speaking, when considering plans in our local area, there are 3 primary health plan types to choose from. They are called HMO (Health Maintenance Organization), PPO (Preferred Provider Organization) and POS (Point Of Service) plans.
Medicare Health Insurance
(For Individuals Age 65 And Older Or Permanently Disabled)
What does Medicare cover (Parts A, B, C and D)?
There are several different types of Medicare plans. The choices vary from the services covered to the type of administrators who manage the plan.
People who are eligible for Medicare commonly choose the Original Medicare Plan or a Medicare Advantage Plan.
Other Types Of Health Insurance
Indemnity Style Products
Indemnity products are designed to provide benefits on a much more defined scope. Some of the more common indemnity products are hospitalization, cancer, short term convalescence, heart attack, accident and dental products.
Long Term Care (LTC)
Coverage that provides benefits for nursing-home care, home-health care, personal or adult day care for individuals with a chronic or disabling condition that needs constant supervision. LTC insurance offers more flexibility and options than many public assistance programs.
An annuity is a contract between you and an insurance company that is designed to meet retirement and other long-range goals, under which you make a lump-sum payment or series of payments. In return, the insurer agrees to make periodic payments to you beginning immediately or at some future date.
This determination will be made based upon household income (adjusted gross income) and number of members in the household.
If you fall within the federal income guidelines, you may be eligible for a subsidy that can pay a percentage or all of your premium. In order to take advantage of the subsidy, you must purchase the insurance through the FFM or State Exchange. If you purchase insurance directly from an insurance company (also known as the Private Marketplace), you will not be eligible for a subsidy.
Although the cost of health insurance is continually rising, it is something that most individuals and families cannot afford to go without. It’s important to understand the different types of health insurance that are available to you so you can choose the right health insurance policy that fits your budget. Learning the pros and cons of each type of health insurance, such as rates, networks and coverage, will help you make an informed decision.
Whether you’re getting a new job and need to decide which type of insurance to choose from your employer or are self-employed and seek coverage for you and your family, it’s smart to stay informed. This empowers you with confidence that you have the right health insurance coverage that offers the protection you need at a price you can afford.
Health insurance is necessary to keep you from falling into debt from an accident or an unexpected health problem. Understanding the difference between insurance plans and knowing what questions to ask will help you choose the right plan.
Health Plan: Health Maintenance Organizations (HMOs)
Health Maintenance Organization, or HMO, is a popular health plan because it is typically less expensive for the insurer than the traditional major medical plan. The costs are reduced through a negotiation with a particular healthcare provider, and the insured is tied to obtaining healthcare services through that network.
How HMO’s works:
- Monthly premiums are paid, and a small co–payment is due for each office visit and hospital stay.
- Your choices are limited to a specific Primary Care Physician network, but exceptions are made in case of emergencies.
- HMO plans typically include preventive care or wellness programs, immunizations, well–baby care, and mammograms, along with regular doctor visits, emergency care, specialist treatments, x–rays, hospital stays and surgery, and other medical services.
- HMO plans are typically the most restrictive when it comes to networks.
- HMO plans can also include dental and vision coverage at an additional cost.
Health Plan: Preferred Provider Organization (PPO)
The Preferred Provider Organization, or PPO, plan shares similarities with HMOs, including the negotiations with a healthcare provider for lower overall healthcare costs. Some people choose PPOs over HMOs because the former plan allows more freedom of choice.
How PPO’s works:
- Your co-payment and deductibles will be lower if you choose a provider that is in the PPO network.
- If the insured wants to utilize a particular doctor or healthcare provider that is out-of-network, they are able to do so (unlike an HMO), but the costs will be higher.
- PPO plans typically include preventive care, regular doctor visits, emergency care, specialist treatments, x-rays, hospital stays, surgery and other medical services.
- PPO plans can also include dental and vision coverage at an additional cost.
Health Plan: Point of Service (POS)
Point of Service, or POS, plans have similarities to HMO and PPOs, offering the cost-saving options of a HMO and the physician choices of a PPO. Under a POS plan, the point-of-service options allow the insured to go within or outside the POS network.
How Point of Service works:
- The insured chooses a primary care physician within the POS network, with cost coverage that is similar to HMO rules.
- If the insured requires a specialist, the primary care physician can refer the patient to a specialist within or outside of the POS network.
- If the insured, or patient, refers themselves outside the network, the insured pays coinsurance under the rules of the POS plan.
- In many categories, POS plans mirror a PPO plan, with a few exceptions.
*Plan Types Are Subject To Availability
The Original Medicare Plan is a fee-for-service plan managed by the federal government. Most people on the Original Medicare Plan have a combination of what is referred to as Part A and Part B benefits. Additionally, recipients of Original Medicare have the option of adding what’s called a Medicare Prescription Drug Plan (or Medicare Part D plan) and purchasing a Medigap or supplemental policy. Medicare Advantage plans are an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) that can provide Parts A, B and D coverage.
Let’s discuss the most common plans:
Different parts of Medicare cover different services. You may hear about four parts of Medicare: Part A, Part B, Part C and Part D.
Original Medicare which is administered directly by the federal government (and is the way most people get their Medicare) has two parts:
Part A (Hospital Insurance) covers most medically necessary hospital, skilled nursing facility, home health and hospice care. It is free if you have worked and paid Social Security taxes for at least 40 calendar quarters (10 years); you will pay a monthly premium if you have worked and paid taxes for less time.
Part B (Medical Insurance) covers most medically necessary doctors’ services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health care, and some home health and ambulance services. You pay a monthly premium for this coverage.
Part C (Medicare Advantage Plans) Medicare Advantage Plans are offered by private companies and approved by Medicare. Members of Part C plans are still on Medicare. Medicare Advantage Plans provide the same coverage as Part A and Part B. Many also provide extra benefits and Part D prescription drug coverage. Types of the Medicare Advantage Plan include: Preferred Provider Organization (PPO) Plans, Health Maintenance Organizations (HMO) Plans, Private Fee for Service Plans (PFFS), Special Needs Plans and Medicare Medical Savings Account (MSA) Plans.
Medicare Part D (Outpatient Prescription Drug Insurance) is the part of Medicare that provides outpatient prescription drug coverage. Part D is provided only through private insurance companies that have contracts with the government—it is never provided directly by the government (like Original Medicare is). If you choose to have original Medicare you will need to enroll in a stand-alone Part D plan. If you enroll in a Medicare Advantage plan, Part D benefits are included in most cases.
Medigap Policy (Medicare Supplemental Insurance) A Medigap policy, or Medicare Supplemental Insurance, is health insurance sold by private companies to fill in the gaps of the Original Medicare Plan. Medigap policies only apply to individuals receiving benefits from Original Medicare Plans (Parts A and B). These individuals pay the private insurance company a monthly premium for their Medigap policy in addition to the monthly Part B premium that they pay to Medicare. Eleven plans, subject to federal and state laws, are available.
If you join a Medicare Advantage Plan, you can’t use Medicare Supplement Insurance (Medigap) to pay for out-of-pocket costs you have in a Medicare Advantage Plan. If you already have a Medicare Advantage Plan, you can’t be sold a Medigap policy. You can only use a Medigap policy if you disenroll from your Medicare Advantage Plan and return to Original Medicare.
As made apparent by the covered product name, these plans will provide benefits for specific services and have limited benefits. In many cases, the benefits of the specified product can be customized to fit your needs. These plans are commonly used to help fill the gaps of primary health insurance plans. Many individuals carry these for the purpose of helping with deductibles, copays or coinsurance that they may be liable for under the definitions of their primary health insurance.
Receiving care for any of the above mentioned categories can be very costly, which is why most people need insurance. Most LTC insurance policies will cover a specified dollar amount for each day you spend in a nursing facility or for each home-care visit. Thus, when considering an LTC insurance policy, compare the benefits to determine which policy will best meet your specific needs. Due to the complex nature of needs, benefits and affordability, speaking to an agent can help identify what is most appropriate for your given situation.
Annuities are primarily used as a means of securing a steady cash flow for an individual during their retirement years. An important feature of annuities versus many other investment vehicles is that the money can grow tax deferred. This means that interest earnings will not be taxable until you withdraw income. In addition, you are typically allowed to take a penalty free withdrawal each year (generally up to 10% of the account value). Although annuities are primarily designed as an investment product, it’s important to include these products under the health insurance category because riders can be attached to many annuities that can provide Long Term Care and other benefits.
There are three primary annuity categories that are available based upon your financial goals.
Fixed Annuities Explained
On a fixed annuity, the insurance company agrees to pay you no less than a specified rate of interest during the time that your account is growing. The insurance company also agrees that the periodic payments will be a specified amount per dollar in your account. These periodic payments may last for a definite period, such as 20 years, or an indefinite period, such as your lifetime or the lifetime of you and your spouse. In many instances, fixed annuities are comparable to a bank CD (certificate of deposit). The primary difference between a CD and a fixed annuity is the tax deferral status and the generally higher interest return of a fixed annuity.
Variable Annuities Explained
In a variable annuity, you can choose to invest your purchase payments from among a range of different investment options, typically mutual funds. The company will provide you with a list of sub-accounts that you can choose to invest your money in. The rate of return on your purchase payments and the amount of the periodic payments you eventually receive will vary depending on the performance of the investment options you have selected. Variable annuities do not typically offer the protection of your principal like fixed and indexed annuities. Of the three types, Variable Annuities are the riskiest due to the fact that your initial principal is not protected like Fixed and Indexed Annuities.
Indexed Annuities Explained
An Indexed annuity is a hybrid annuity that combines many of the benefits of the fixed and the variable annuities. In an indexed annuity, the insurance company credits you with a return that is based on changes of a chosen index, such as the S&P 500 Composite Stock Price Index. Indexed annuity contracts also provide that the contract value will be no less than a specified minimum, regardless of index performance. Your principal is not subject to market risk. Indexed annuities have become an extremely popular and safe way for individuals to invest their money.
All information Referenced on qcfreequote.com is intended to provide a basic understanding of policy benefits. In no way does it provide a definitive explanation to policy benefits and should be considered a basic learning tool. Coverage, language and definitions will be specific to your policy and the information on this website should not be referenced when determining active benefits.