Obamacare / On Exchange
This is the only place where you can purchase health insurance and receive government assistance for premiums and cost sharing. If you are eligible for a subsidy then this is where you need to go. As Marketplace certified Brokers we can help you apply for your subsidy, understand your coverage, enroll in a health plan and help you resolve claims issues…for no additional costs.
Health plans that are not purchased through the government website are considered off exchange. These are the same plans as the ones that are sold On the Marketplace website, at the same price. But, there are other plans available offering different networks and benefits. Shopping OFF the exchange will give you more options but it probably won’t be any cheaper.
HMO’s And PPO’s
There are two basic types of health insurance plans available in the family and individual health insurance market. These are Health Maintenance Organizations – HMO’s, and Preferred Provider Organizations – PPO’s. Each has it’s pro’s and con’s.
HMO’s stress preventative maintenance, early diagnosis, and outpatient surgery with regards to your medical care. HMO’s are not available in all areas but they do tend to be cheaper.
No matter what type of health insurance policy you get they are all going to have some kind of system in which you share costs with them. HMO’s use a co-payment system and PPO’s use a deductible and co-insurance. Nowadays there is a lot more crossover as the health insurance companies try to improve the benefits or lower their premiums.
When using an HMO, a doctor visit could have a copay of $10-$75+ for the office visit (depending on the plan) or if you have to go to the ER, then it might cost you as little as $100 or much more (depending on the plan). Different HMO’s have different co-payments. This where the metal levels help to sort it all out. Platinum and Gold level health plans have lower copays and deductibles than Silver or Bronze level plans.
Not all covered benefits have co-payments, which means that is is subject to the deductible and you will have to pay until your annual deductible is met. One of the biggest benefits of having insurance is control over costs. You will not be paying full price. You will be paying the pre-negotiated or contracted rate arranged by the health insurance company with your in network provider. Each service or provider is going to have different rates so it is a good idea to check around. What you spend is applied to your annual deductible. Once you meet your deductible then the health insurance company starts to pay. This is where that co-insurance kicks in.
PPO’s offer you much larger networks and you are not required to get a referral to see a specialist. They also tend to cost more to use. It is important to note that not all networks are the same. Depending on the area where you live the size and quality of the preferred provider networks will vary. It is best to check the PPO networks first to see if your preferred doctors and hospitals are in the network. I suggest you also call your doctor and ask him/her which companies they accept.