If you need help understanding your ACA Individual Health Insurance plan if you can get a subsidy, differences in PPO, HMO, or POS plans we have some information to help you better understand your options.
We have seen that both on the Marketplace or Exchange and off of the Marketplace plans are much different that what we had in the past. One thing for sure is you need to understand what you are buying for your coverage. We do have HMO, PPO, and POS plans in Texas and you really need to check that the networks you are considering of enrolling in especially if you have particular doctors as a requirement. If you do not understand the difference in network types you should before you sign up.
HMO – Health Maintenance Organization, these plans offer lower cost for the premiums, but they do require a selection for a Primary Care Physician (PCP) and you can ONLY use doctors in the network – NO COVERAGE for using doctors or services out of network. This is the PCP you are requred to go to first for all your basic healthcare services. They will evaluate your issue and could refer you to a specialist if needed. The good thing about the HMO network is it keeps the cost down and your PCP will know you and your health history very well. They call him the gate keeper to referrals to specialists only when needed. Some clients do not like the loss of flexibility with this type of plan that they need to get referrals and that they can only use doctors in network.
PPO – Preferred Provider Network, this is a network of physicians that have agreed to the carriers terms for being in the network. PPO plans you do not need to select a PCP (Primary Care Physician). If you use in network providers, you are offered copays and the costs apply toward your in network deductible. In network providers offer lower costs, if you go out of network for a provider, usually they will cost more. With a PPO plan you are able to self refer to a specialist, without needing a referral from a PCP.
POS – Point Of Service – this is basically a combination of a HMO and PPO plans. This plan does allow going in and out of network like PPO, and you may be asked to select a Primary Care Physician. You can be referred by your PCP to a specialist and you can self refer as well.
No matter which type of plan you are considering HMO, PPO or POS it is important to check that your doctors are part of the network to keep you costs down. We have seen as we have been enrolling people that some people find out that they plan they felt best, did not have their doctors participate in. It is worth checking before you get locked into a plan that you cannot go to see your favorite doctor.
If you are struggling with what to do, reach out to a local agent to help you narrow down your choices and have a dialog about your specific requirements. There is no additional cost to working with an agent/broker, and you will have a personal advocate of you have any trouble. They can help you enroll on or off of the Marketplace. We do many enrollments and review the plans so we can help you to navigate the available plans. Give us a call should you like some personalized help if finding the best options for you and your family.
As we approach the end of February, we have been helping people figure out the best ACA individual health insurance plan for their specific situation. We still have time to enroll during the open enrollment period through March 31st, then the window will close until 2015. If you have not figured out what plan is best for you, there is still time for enrollment either with a subsidy on the Marketplace or off the exchange. Take your time when you are selecting the plan for you.