The passage of the affordable Care Act established the health care Marketplace. There are two distinct divisions – a state level, and a federal level. thirty seven states are members of the federal exchange, and fourteen are restricted to a state exchange. sadly, not all insurance firms are needed to supply data regarding their plans and costs to the health care Marketplace, thus be ready to try and do some native looking for reasonable plans in your space.
The health care Marketplace can also be mentioned because the insurance Marketplace. it’s a web site managed by the federal. once you visit, you’ll enter some personal details regarding yourself and begin buying plans in a very matter of minutes.
There are infinite choices available for the average consumer. The question that most consumers are asking themselves are focused solely on what plans are available to them within the marketplace. The federal and state insurance exchanges have more options but they are limited. However, they do offer a wide selection of plans within their product lines. They have plans that are individual members all the way up to larger plans for family, however the options vary. With your own due diligence in comparing the plans that are available for you, it is not so hard to find a plan that works for you or yourself and your dependents.
It is important to understand that insurance companies must prove reliability and legitimacy in order to be placed on the marketplace exchange, for both federal and state. There is a certain level of a selection process that reviews factors such as: customer satisfaction, BBB (Better Business Bureau), financial solvency, to name a few. For larger insurance companies like Blue Shield or Aetna, the process is far simpler because it is based on reputation and brand longevity alone. However, for smaller companies that work within strict regional or specialized platforms are usually put through a far more stringent process.
When it comes to the consumer the marketplace serves as a tool in understanding what plans are available to them. It is an initial step to understand the various plans that are available within your budget and what best suits your needs.
Obamacare – a nickname for the Affordable Care Act. Its full name is the Patient Protection and Affordable Care Act. Obamacare was signed into law by President Barack Obama in March of 2010.
Healthcare (insurance) Marketplace – a resource for those without health insurance to find affordable coverage through either a state or federal exchange. Again in his marketplace are the Obamacare (e.g. Affordable Care Act) plans that are available. Obamacare is best for those who are eligible for the subsidies (see below more on Obamacare subsidies).
Subsidized Health Insurance – The passing of the Affordable Care Act (Obamacare) began the process of subsidizing (offering at a lower cost) health insurance plans for those who cannot otherwise afford health insurance and medical care.
Medical Insurance – another term for health insurance. Also synonymous with healthcare plans and medical coverage.
Health Insurance Companies – companies which underwrite (provide) health insurance plans. They are responsible for paying out claims when their beneficiaries (customers) receive medical care.
Health Insurance Quotes – most health insurance companies are required to give you an accurate estimate of what you should expect to pay as well as the terms of your health insurance plan, should you decide to do business with them. These estimates are commonly referred to as a “quote”.
Premium – the monthly cost you must pay to maintain your health insurance coverage. Also sometimes referred to as a “monthly premium”.
Deductible – a fixed dollar amount your insurance company will require you to pay out-of-pocket for your medical care before they will pay out any claims. The deductible and monthly premium are inversely related: the higher the premium, the lower the deductible, and vice versa.
Three little letters make a lot of difference to your health insurance plan. If you can tell the difference between 4 types of insurance networks, then you’ll understand how your medical care, costs, and plan type fit together.
The two main health insurance network types to know are:
Preferred Provider Organizations (PPOs) and
Health Maintenance Organizations (HMOs).
An HMO is generally cheaper than a PPO, but HMOs will have fewer doctors available. There are two other common network types:
Point of Service (POS) and
Exclusive Provider Organizations (EPO).
These combine features from HMO and PPO networks.
PPO (Preferred Provider Organization) Health Plan Definition:
PPOs rarely require a referral to see medical providers.
If you have a PPO plan, you can visit any provider in your plan’s network at a discounted (“preferred”) rate.
PPO networks include independent medical providers and hospitals.
PPOs allow you to visit doctors that aren’t in your PPO network, but you’ll be responsible for more of the cost.
Your PPO may have an entirely separate deductible and out-of-pocket maximum for out-of-network medical professionals.
PPOs are generally the most flexible network type.
PPOs are generally the most expensive network type.
HMO (Health Maintenance Organization) Health Plan Definition:
To use an HMO network, you’ll choose a primary care physician (PCP) to coordinate your medical care.
Referrals from your PCP are usually required to visit a specialist.
HMOs limit you to a relatively small network of in-network doctors and hospitals.
During emergencies, your HMO will cover out-of-network care.
In-network doctors may be directly employed by your insurance company.
Some HMO networks put more limits on the number of tests or treatments than PPO networks.
HMOs are generally less expensive than other networks. There are fewer doctors to pay, and your primary care provider (PCP) has an interest in keeping you healthy.
However, it can be burdensome to contact your PCP before making healthcare decisions.
For example, if you had a skin issue, you might have to see your PCP to get referred to a dermatologist.
POS (Point of Service) Health Plan Definition:
POS networks are like HMOs, but without strict network limits.
Unlike HMOs, POS networks partially cover non-emergency care from doctors who aren’t in your plan.
POS networks ask you to get referrals from your primary care physician (PCP) before seeking care from specialists, like an HMO would.
Depending upon the plan, preventive care and other services rendered by your PCP may be heavily discounted.
POS networks are generally less expensive than PPOs and more expensive than HMOs.
EPO (Exclusive Provider Organization) Health Plan Definition:
EPO networks are like HMO networks, but without difficult referral rules.
Unlike HMOs, EPO networks do not require referrals from a primary care physician.
You’ll still be able to get non-emergency care only from specific doctors who accept your EPO.
EPOs are generally less expensive than PPOs and more expensive than HMOs.