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plans for people with chronic needs and conditions

AW Elliott & Associates Certified Financial & Tax Advisor
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AW Elliott & Associates

With the Affordable Care Act being passed, some features of health coverage have changed while others remain the same. To determine the right health insurance coverage for you and your family, AW Elliot & Associates is here to help you understand how health insurance meets your various needs. Here is a brief overview of the different types of coverage available to you.

Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations (EPOs)

HMOs and EPOs may limit coverage to providers within their networks. A network is a list of doctors, hospitals, and other health care providers who offer medical care to members of a certain health policy. If you seek the help of a doctor or facility that isn't in the HMO’s network, you may have to pay the full cost of the provided services.

HMO members typically have a primary care doctor and must get referrals to see specialists. In general, this is not true for EPOs.

Preferred Provider Organizations (PPOs) and Point-Of-Service Plans (POS)

These insurance policies offer you a choice of receiving care inside or outside of a provider network. With a PPO or POS, you may utilize out-of-network providers and facilities, but you’ll have to pay more than if you use in-network ones.

You can visit any doctor without a referral if you have a PPO policy. If you have a POS policy, on the other hand, you can visit any in-network provider even without a referral. However, you’ll need one to visit a provider out-of-network.

High Deductible Health Coverage (HDHP)

High Deductible Health policies usually feature lower premiums and have higher deductibles than a common health insurance policy. As of 2016, HDHPs are policies with a minimum deductible of $1300 annually for individual coverage and $2600 for family coverage.

If you have an HDHP, you can use a health savings account or health reimbursement arrangement to pay for qualified out-of-pocket medical expenses. This can reduce the amount of federal tax you owe.

Catastrophic Health Insurance

Catastrophic health insurance covers important health benefits but has a very high deductible. This means it provides you with a kind of safety net coverage in the event of an accident or a serious illness.

Catastrophic policies typically do not provide coverage for services like prescription drugs or shots. Premiums for catastrophic policies may be lesser than traditional health insurance coverage, but deductibles are typically much higher. This means you ought to pay thousands of dollars out-of-pocket before full coverage takes effect.

You must be under the age of 30 or be eligible for a hardship exemption to qualify for a catastrophic plan. A hardship exception means you can’t afford health coverage by the Marketplace.

Marketplace catastrophic policies cover three annual primary care visits and preventive services without any cost. After the deductible is met, they cover the same set of health benefits that other Marketplace policies offer. People with catastrophic coverage are not qualified for lower costs on their monthly premiums or out-of-pocket costs.

Each option has various pros and cons, and it is vital that your selection will meet your needs. Get in touch with us today to let us guide you in choosing the right policy for you and your family.

Supplemental Health Insurance Overview

If you are involved in an accident or diagnosed with a serious illness, traditional health insurance programs such as Medicare and Workers' Compensation may not pay for all your needed services.

As implied by its name, supplemental insurance gives you another layer of protection, on top of existing policies you might already have, such as health and life insurance. It can assist you in paying for care and services that existing policies may not cover.

Supplemental insurance is the same with other types of insurance, but it’s not meant to be the only way of protecting yourself. While major medical or life insurance policies can provide the majority of benefits to your family after a loss or an illness, supplemental insurance benefits can be used to pay for unanticipated out-of-pocket expenses.

Types of Supplemental Insurance

The coverage of supplemental insurance policies includes the following:

  • Cancer

  • Heart Disease

  • Accident

  • Disability Income

  • Hospital Indemnity

Supplemental insurance policies fall into two major categories. There are those that provide a one-time lump sum benefit and others that are based on expense. Accident and hospital indemnity policies are usually indemnity-based. This means that the policy covers specific amounts for certain covered injuries or conditions.

Note: Not all options are available in all policies or all states.

Start Considering Supplemental Insurance If:

  • You have primary health insurance.
  • You are not financially ready to pay for care that you may need due to a major illness or accident.

It is important to note that supplemental insurance is not supposed to replace primary health insurance. However, it can help you with the extra costs due to a serious or chronic illness.

Helpful Resources

Read these links from CMS to learn more about health insurance:

Health Insurance