Medicare is a federal health program for people 65 years of age and older. When choosing a Medicare plan, there are a lot of terms to understand and know. The most basic of terms are outlined here for your convenience:

• Premium: the monthly amount you pay to have the plan
• Deductible: the amount you must pay up to before your medicare plan incurs the costs
• Co-pay: the specific amount your insurance asks the insurer to pay for specific services
• Co-insurance: the percentage amount the insurer is responsible for after your deductible is met
• Max-out-of-pocket limit: in the worst-case scenario, this is the most the insurer would be responsible to pay for

Outside of these core terms, there are other things about medicare to know. Health Plans of America makes it easy by connecting you to a licensed insurance agent. Connect today to get started!

In the complex landscape of health insurance, individuals often find themselves confused by the array of options available. It’s crucial to understand the nuances of each plan to make an informed decision about your healthcare coverage. In this guide, we’ll delve into three prominent health insurance plans, shedding light on their distinctive features and helping you determine which one aligns best with your needs.

1. Health Maintenance Organization (HMO) Plans:

Health Maintenance Organization plans, or HMOs, are among the most popular choices for individuals seeking comprehensive coverage within a designated network. With an HMO, subscribers are required to select a Primary Care Provider (PCP) who oversees their healthcare journey. The PCP acts as a gateway, coordinating all medical services, including referrals to specialists.

Pros:

• Cost-effective: HMOs generally have lower out-of-pocket expenses.
• Comprehensive care: Centralized coordination ensures a holistic approach to healthcare.
• Ideal for regular PCP visits: Suited for individuals who prefer consistent visits to their primary care physician.

Cons:

• Limited flexibility: Going out-of-network may result in additional fees.
• Referral requirements: Specialists need approval from the PCP, potentially causing delays.

2. Preferred Provider Organization (PPO) Plans:

Preferred Provider Organization plans, or PPOs, offer a more flexible approach to healthcare. Subscribers have the freedom to visit any healthcare provider within the network without requiring a referral, making it an attractive option for those who frequently consult specialists.

Pros:

• Greater flexibility: No need for referrals to see specialists.
• Nationwide coverage: Access to a broad network of healthcare providers.
• Out-of-network options: PPOs provide partial coverage for services obtained outside the network.

Cons:

• Higher premiums: PPOs generally come with higher monthly premiums.
• Increased out-of-pocket costs: Choosing out-of-network providers may lead to higher expenses.

3. Exclusive Provider Organization (EPO) Plans:

Exclusive Provider Organization plans, or EPOs, strike a balance between HMOs and PPOs. Subscribers have access to all healthcare providers within the EPO network, including specialists. This plan is ideal for individuals who infrequently visit their primary care physician and are comfortable with a more restricted provider network.

Pros:

• Comprehensive coverage within the network: Access to specialists without referrals.
• Lower premiums compared to PPOs: EPOs often have more affordable monthly costs.
• Suitable for those not requiring frequent PCP visits.

Cons:

• Limited out-of-network coverage: EPOs typically do not cover services obtained outside the network.
• Less flexibility compared to PPOs: Subscribers must adhere to the EPO network.

Choosing the right health insurance plan is a critical decision that hinges on personal preferences, healthcare needs, and budget considerations. Health Plans of America is committed to simplifying this process by providing the tools and resources necessary for a hassle-free insurance buying experience. Whether you are a first-time buyer or considering a policy change, arming yourself with knowledge about HMOs, PPOs, and EPOs will empower you to make an informed choice tailored to your unique circumstances.

It is in the best interest of your health insurance to ensure that you are healthy. That’s why companies offer certain perks and benefits to help keep your health on track. Depending on your insurance carrier, taking advantage of these perks can even get you discounts on some of your favorite things. Here are some of the things health insurance companies are giving to their members:

• • Money for meeting your walking steps goal – some insurance companies have apps that allow you to set goals and track progress. For reaching or surpassing your goals, you can get gift cards as a reward for taking care of your health.

• • Gym fee reimbursement – even though gyms can be expensive, health insurance companies want you to go to take care of your health. Some will offer a reimbursement for you and sometimes even your spouse.

• • • Call your doctor or nurse for free – depending on your healthcare provider, you can call your doctor or nurse, talk about your symptoms, and then they’ll tell you your next steps. Whether it be an in-person visit or staying at home and resting, you’ll know what to do.

   

  • Free preventive care – according to the Affordable Care Act, those who had insurance plans by March 23, 2010, will have their preventative care visits covered. Things like blood pressure tests, breast or colon cancer screenings, routine vaccines, HIV screenings, and well-baby visits are all considered preventative care and are covered.

Get full access to all these amazing benefits by talking to your insurance provider today!

Need to get started? Health Plans of America can match you with a healthcare plan that meets your needs at a price you can afford. Call today to get connected to a health insurance provider.

On Tuesday, September 27, 2022, the Centers for Medicare & Medicaid Services (CMS) announced that the monthly premiums, deductibles, and coinsurance for Medicare Part A and Part B are expected to decrease by about $5 (or 3%) in the coming year. This is the first time a cost like this has been lowered in more than a decade.

According to Health and Human Services Secretary Xavier Becerra, federal spending on the new Alzheimer’s drug, Aduhelm, will not be as high as initially projected, which has contributed to this pay decrease in premium.

Medicare Part B covers things like doctor visits, certain home health services, durable medical equipment, and other medical and health services that are not covered by Medicare Part A. 

Each year the Medicare Part B premium, deductibles, and coinsurance rates change (typically as an increase), depending on the Social Security Act. In 2023 the standard monthly premium for enrollees of Medicare part B will decrease to $164.90 from $170.10. 

2023 Open Enrollment for Medicare will begin on October 15 and will end on December 7, 2022. People eligible for Medicare can compare coverage options between Original Medicare, Medicare Advantage, and Part D prescription drug plans for 2023. 

Need help choosing a plan? Connect with one of our licensed insurance agents today and compare plan options.

Health insurance terminology can be hard to follow at times, but we’ve broken down the five most important ones to note:

• • Premium – while you pay a monthly bill for your health insurance, the cost of said premium doesn’t necessarily equate to the cost of the health care services.

• • Deductible – this is the out-of-pocket amount you must pay for health care services before your health insurance takes effect. Once you’ve paid your deductible, you still may be required to pay copays or coinsurance until you hit your limit for those payments.

• • Copayment – also known as “copay” is a fixed amount you pay for a service or medication. This is often the way health insurance companies will split the cost with you after you’ve met your deductible.

• • Coinsurance – unlike copay, coinsurance is not a fixed cost. Instead, it’s a percentage of the cost you pay for covered insurance until you reach your out-of-pocket maximum.
    
    
  • Maximum out-of-pocket – this is sometimes called the out-of-pocket limit, which is the most you would ever have to pay for health care services in a year. Every dollar you pay toward your deductible, copayment, or coinsurance counts toward your out-of-pocket limit. Monthly premiums, on the other hand, don’t count.

Having an understanding of these terms will help you make better choices surrounding your health insurance. With the help of Health Plans of America, looking for the right health insurance is hassle-free. Get connected with a licensed insurance agent to find a health care plan that works for you and your budget.

In a society where health and safety are rapidly changing, having Medicare coverage is of the utmost importance. However, Original Medicare does not account for office visits and prescriptions. That is where a Medicare Supplement Plan, also known as Medigap, comes to your aid.

Since most Medigap plans are standardized and can be used with any medical provider who accepts Medicare, having a Medigap plan gives you all the added benefits while staying with the doctor you feel most comfortable with.

There are three ways in which Medigap plan premiums are calculated: issue-age rated, attained-age rated, and community rated. Understanding your needs and options will help you determine which plan and insurance provider to choose. Still have questions and want more information? Health Plans of America does all the hard work for you by offering information and resources to help you make informed decisions. Don’t wait!