Health Insurance Blog and Resources

The health insurance industry is permeated with acronyms. These simple three-letter abbreviations may leave you wanting to say four-letter words. A health insurance insider may casually say such nonsense as, "You can use your HSA to pay part of the OOP expenses on your HDHP plan." This stream of three-letter abbreviations sounds like gibberish and might as well be written in hieroglyphics (I'd like to sign up for the flax-owl-lasso plan, please). If you don't speak "health insurance," you may often feel in the dark. Even worse, you may not fully understand your plan or coverage. Below you will find some common acronyms to help you navigate this foreign tongue. Consider this your Rosetta Stone. Acronyms for Types of Health Insurance Plans PPO: Preferred Provider Organization Preferred Provider Organization plans allow customers to receive care from doctors and hospitals both inside and outside of their network. This type of plan usually provides customers with a list of in-network facilities and physicians who have agreed to a discounted rate. Customers can choose from a list of doctors within their network. Visits to providers outside of the network require additional costs. PPOs are the most prevalent type of health insurance plan enrolling 48% of covered workers. HDHP: High-Deductible Health Plans High-Deductible Health Plans (also known by another acronym: CDHP, or Consumer Driven Health Plan) have significantly higher deductibles than other plans. These plans usually cover free preventative services; however, any other costs are first covered by the customer. Once the deductible is met, the insurance company will cover additional charges. Though customers pay for services until they meet their deductible, they receive negotiated rates when going to in-network providers. Visiting out-of-network providers leads to extremely high costs. HDHP plans are become increasing popular, with 29% of covered workers enrolled in 2016. In addition, these plans may include a (HSA) Health Savings Account. Customers may use this savings account to pay for medical expenses. They may put aside pre-tax money for health expenses. Sometimes employers will also contribute to this account. HMO: Health Maintenance Organization Health Maintenance Organization plans allow members to choose from a list of in-network primary care physicians. They do not cover services outside of their network (except in an emergency). Typically customers will need a referral to see a specialist. These plans typically have lower premiums than PPOs. Approximately 15% of health plans are HMOs. POS: Point of Service Point of Service plans are similar to HMOs with a notable exception: customers must choose a primary care physician within the plan's network. However, customers may visit doctors out of their network, but they will pay most of the cost. However, if customers are referred to an out-of-network specialist by their primary care physician, their insurance will typical pay more of the cost than with no referral. EPO: Exclusive Provider Organization Exclusive Provider Organization plans only cover visits to providers within the plan's network (except in an emergency). Customers do not need a referral to see an in-network specialist with this type of plan. Out-of-network services are not covered. Other Acronyms PCP: Primary Care Physician A primary care physician is your main doctor, often a general practitioner. This doctor typically performs preventative exams and assists with general medical needs. HSA: Health Savings Account Health Savings Accounts often accompany HDHPs (see above). You may put pre-tax earnings into this account and use it for qualified medical expenses. ACA: Affordable Care Act The Affordable Care Act is the 2010 health care reform law. You can read more about the law here. CS: Cost Sharing Cost sharing refers to deductibles, co-payments, and other similar payments. It is the share of costs the customer must pay for covered benefits. OOP: Out of Pocket Out of pocket refers to the amount that customers pay, up to a certain maximum, in a year. Once the out-of-pocket maximum is reached the insurance covers all other expenses. Deductibles, co-payments, etc. contribute to this amount. It does not include premiums. EOB: Explanation of Benefits An explanation of benefits is a document that describes services received. It helps customers understand their coverage and the amount owed for a given service. OV: Office Visit An office visit is when a patient goes to the doctor for a specific medial problem, rather than a general check-up. CHIP: Children's Health Insurance Program The Children's Health Insurance Program provides inexpensive insurance for children in low income households who do not qualify for Medicaid. Read more information about CHIP here. QHP: Qualified Health Plan Qualified Health Plans meet the requirements described in the Affordable Care Act with specified price limits and covered benefits. In addition to this list, there are a plethora of other health insurance acronyms. Take time to learn this complex language so you can understand your insurance coverage and benefits. When choosing a health insurance company, you need the most helpful and accurate information. Check out our top rated companies and find the one that best meets your needs here.  

Open enrollment is upon us! From November 1 through December 15 people will have the opportunity to either sign up for health insurance, or make changes to their existing coverage. If you're on Medicare, the Open Enrollment Period started October 15 and ends December 7. Read these articles about Medicare Annual Enrollment and Medigap to learn more about Medicare and how to take advantage of the Annual Enrollment Period. Below are some important dates for Open Enrollment that you'll want to pay attention to as you make your decisions: November 1, 2021: Open Enrollment Starts December 15, 2021: Last Day to Enroll or Make Changes for Coverage starting January 1, 2022 Of course, if you've never signed up for health insurance before, there are some questions you'll need to ask yourself about your situation before you enroll. Health insurance in this country can be complicated, so before you can know what your options are, you need to understand how your circumstances influence your access to health insurance. Are you employed? While you don't need to be employed to have access to health insurance, it certainly helps. Many employers in the country offer some kind of health benefits to their full-time employees. Some also offer it to their part-time employees. Does your employer provide insurance? Of course, not every employer offers health insurance. As healthcare costs increase, fewer and fewer businesses can afford to provide health insurance benefits to their employees. If you're employer doesn't offer health insurance, you can see what insurance companies offer to individuals and families. You may even qualify for an income-based subsidy or another government health insurance program. Is your job-based insurance sufficient? By "sufficient" we mean, does the insurance coverage your employer provides able to meet all of your healthcare requirements? This question might be more difficult to answer than you think. How do you know if your employee benefits are enough or not? Unfortunately, the answer to this question depends on a lot of factors: your preexisting conditions, what benefits and packages are available, and whether you can afford necessary add-ons to your policy. First, it's important to do some research on the insurance provider your employer has partnered with. We've identified and reviewed some of the major health insurance companies in operation today. You should also talk to your company's human resources representative (if you have one) to discuss your specific needs, and whether your company's insurance will be able to address these needs with the packages available. If your employee benefits are enough If the insurance provided by your employer is enough to cover all your healthcare needs, then great! You're in good shape; however, it's still important to familiarize yourself with some crucial terms related to your health insurance policy. If your employee benefits aren't enough If your insurance policy does not quite cover all of your healthcare needs, that's okay! You can look at your options on your state's health insurance exchange. These Health Marketplace plans can give you access to group premium rates that may be cheaper than other options with comparable coverage. You can also consider other options through insurance companies, like off-exchange plans. Off-exchange plans do not cover all of the essential health benefits, so pay attention to what services are covered if you're looking at these plans. Is your income less than 138 percent of the Federal Poverty Level? The Federal Poverty Level is a standard against which you can determine whether you qualify for cost assistance when buying insurance through the Health Insurance Marketplaces. If you make less than 138 percent of the Federal Poverty Level, you may qualify for Medicaid or CHIP (Child Health Insurance Program), depending on whether your state has expanded Medicaid coverage (more on that later). If your income is greater than 138 percent of the Federal Poverty Level You'll still have a number of health insurance options available to you. The Health Insurance Marketplace offers a insurance packages on a sliding scale, meaning your income (along with other factors) can influence the number and variety of benefits you can potentially receive. If you fall into this group, you may also qualify for certain insurance subsidies, as follows: Premium Tax Credits Based on income, these premium tax credits can go towards paying for a portion of your health insurance costs by either lowering your premium, for factoring into your annual tax return. More specifically, if you make between 100 percent and 400 percent FPL, you may qualify for these credits. Out-of-Pocket Cost Assistance Out-of-pocket cost assistance (also known as cost sharing subsidies) will help lower the amount of money you yourself pay towards specific health insurance costs. These include deductibles, copayments, and coinsurance costs. In order to qualify for these subsidies, you must be making between 100% and 250% FPL. Has your state expanded Medicaid? Right now, one of the major issues affecting health insurance access is the expansion of Medicaid. Medicaid is a health care program (jointly funded by the federal government and the individual states) specifically designed for low-income people. It covers children, the elderly, the blind or otherwise disabled, and others who qualify for federally assisted income maintenance payments. Currently, Alabama, Georgia, Kansas, Florida, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, Wyoming are the only states that have not expanded their Medicaid programs. If your income is less than 138 percent of the Federal Poverty Level, and your state hasn't expanded Medicaid You should still apply for Medicaid coverage, as you still may qualify. However, if you still don't qualify for Medicaid and your state hasn't expanded this type of coverage, you may not be completely out of luck. In some areas, there are Federally Qualified Health Centers that offer primary care services in areas with underserved people. The Health Resources & Services Administration funds these centers through its Health Center Program. You can also buy a catastrophic health plan. These plans only offer coverage for emergency medical care and serious injuries. Because the coverage is so limited, the premiums tend to be much lower. If you're 30 or older, you have to file a hardship exemption form before you can purchase one of these plans. If your income is less than 138 percent of the Federal Poverty Level, and your state has expanded Medicaid You may qualify for Medicaid or CHIP. Rules for Medicaid will vary state to state, so it's important that you check state laws to see how Medicaid has been specifically expanded. As for CHIP, there are some important step, including visiting www.insurekidsnow.gov, selecting your state, then filling out a Marketplace application. Understanding your health insurance options In conclusion, the health insurance world doesn't need to be so intimidating. There are a lot of great resources available for first-time health insurance enrollees. Just be sure to closely examine your situation, the needs of your family, and never be afraid to ask those who have been there before. Health insurance is one of those things you'd rather have and not need, rather than need and not have. The clock on open enrollment is ticking, so sign up today!