The Update – April 15

The Update is an effort to provide my clients with news that they can use to make informed decisions and understand insurance trends.  Click the button below to read the entire newsletter.

The Update April 15

 

 

You Don’t Have To Lose Your Doctor Just Because You Got An Obamacare Plan

Drawn by Steve Sacks for The Star Tribune

Drawn by Steve Sacks for The Star Tribune

Like many American’s, I enjoy the occasional political cartoon.

The art form has been a part of American politics for a couple of centuries.  The future of political protest may be found in the internet, but the history of political protest can be traced in political cartoons.

Last Friday I saw this cartoon from Steve Sacks in The Star Tribune.

He got one thing partially right.  Both Mr. Obama and Republican Leaders have said those words, or words like them.

However, neither of them are telling the entire truth.  If you have already established a relationship with a doctor, you are free to maintain that relationship, if you want.  Regardless of what any politician says, you can still use any doctor you want.  It just may be under different circumstances than you are used to.

INSURANCE

During the recent “Obamacare” rollout Americans were given choices.  Not only were they allowed to choose between Bronze, Silver, Gold and Platinum levels of coverage, they were also allowed to choose between insurance companies.

Where I live, there were 5 different insurance companies to choose from.  Two sold only HMO style plans.  Two sold only PPO style plans.  One sold both styles. (I only contracted to work with 3.) 

Those companies that only sold HMO style plans were the least expensive.  However, they also had the smallest networks of providers.  If a member seeks non-emergency medical care from a doctor/hospital that outside of the HMO network, they will have no insurance protection.

People who purchased those plans are the ones who may no longer be able to keep going to a doctor they like.  They chose their health insurance based on the cost of the premium.

All of the companies, with which I contracted, are PPO style plans.  Yes, they are, in some cases, more expensive than their HMO competitors, but they have a couple of major differences.

  1. The list of doctors/hospitals who have elected to participate in PPO networks is significantly greater than the list of doctors/hospitals who have elected to participate in the less expensive HMO networks.  It is not uncommon for there to be 4-6 times the number of providers in a PPO than in a HMO.
  2. If you have a PPO and elect to seek health care treatment from a doctor/hospital that is not in the plan’s network, unlike the HMO you will still have insurance protection.  It will just require you to pay more of the bill than if you had used a provider that is in the PPO network.

DIRECT PAY

Technically speaking, there is nothing in “Obamacare” that prevents you from using whatever doctor/hospital you wish.  The recent National Open Enrollment, that made so much news, has nothing at all to do with health care reform.  It was all about health insurance reform.

If you already have a doctor, with whom you have developed a relationship of trust and respect, you can continue to see that doctor, regardless of his/her membership in your insurance plan’s network.

Just realize that if you purchased a HMO style policy, because it was less expensive, you will have to pay cash to your doctor.  Many doctors charge a higher fee to their patients who do not have health insurance, so be ready to pay much more than you would have if you had changed doctors to use one that is already in the HMO network.

If you have a PPO policy and elect to use a provider that is not in the network, you will still be charged a higher rate by your doctor, but your insurance company will give you some help with that payment.

In addition, most PPO plans have a “Stop-Loss.”  After you have paid so much money to doctors that are not in the PPO network, your insurance company will pay 100% of your medical bills for the rest of the year.

FIN

Both HMO and PPO plans are excellent plans, provided you understand, and follow the plan’s rules.  However, the PPO is much more forgiving if you make a mistake.

The HMO concept was first tried in the 1980s.  Although a handful of HMO systems survived, most lost their membership, over a few years, as Americans became increasingly upset by HMO restrictions.

I am curious to see how many Americans, who chose HMO plans for the lower premiums in 2014, will switch to the more expensive PPO plans for 2015.

Now that the National Open Election is over, I feel comfortable talking about an option for those Americans who elected not to purchase an “Obamacare” plan for political or financial reasons.

If you live in Texas, click the banner below to learn more about Short Term insurance.  It is built on a PPO platform so you do not have the same limitations as you do with HMO plans, but they are significantly different from Mr. Obama’s Essential Benefit Plans.

Non-approved plans