ej insurance

What type of health insurance plans are there?
Basically, there are two types of health insurance: Managed Care and Fee-for-Service.

Managed care is a way for insurers to help control costs.  It manages how much you use. These plans provide comprehensive health services to their members and offer financial incentives to patients who use the providers in the plan. For example, if you need hospitalization, managed care might require prior approval from your health insurance company. If your admitted without approval, your hospital bill may not be covered.  Plans work differently and can include: health maintenance organizations (HM0s), preferred provider organizations (PPOs) and point-of-service (POS) plans.

• Health Maintenance Organizations (HMO) is a prepaid health plan.  HMOs provide comprehensive health care including doctor visits, hospitalization, emergency room visits, surgery, lab tests, x-rays, and therapy.  An HMO arranges for health care in its own group or through doctors and health care professionals under contract.

• Preferred Provider Organizations (PPO) is a traditional fee-for-service and an HMO combination.   There are a limited number of doctors and hospitals to choose and most of your medical bills are covered.

• Point-of-Service Plans (POS) offer an indemnity-type option where the primary care doctor in a POS plan make referrals to other providers in the health plan.  The health care plan pays all or most of the bill. If you visit a provider outside the network and service is covered, you will have to pay coinsurance.

Fee-for-Service health plans, the insurer pays only part of your doctor and hospital bills. You pay a monthly fee, called a premium. This type of health insurance offers the most choices of doctors and hospitals.  Patients are seen by a doctor of their choice and the claim is filed by either the medical provider or the patient.  You can choose any doctor and hospital. 

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How does the Affordable Care Act (Obamacare)affect you?
The health insurance coverage you need to avoid a tax penalty under the Affordable Care Act (a.k.a. Obamacare) is one that satisfies the Minimum Essential Benefits. Find out if you qualify for a premium tax credit by visiting this website: http://kff.org/interactive/subsidy-calculator/.