Thursday, February 20, 2014
Here are some tips Obamacare Coverage: Stay In Network, Avoid Out-Of-Pocket Costs You purchased insurance through one of the online Affordable Care Act exchanges,or direct through the insuirnace carrier, possibly after a lengthy time of trying to get the site to work. Don't relax just yet. Joining the plan is the first challenge. Now you have to understand it. Policies sold through the online portals cover essential benefits and put a cap on your out-of-pocket medical costs. One needs follow the rules. The boilerplate explanation you got from the insurance company may not be easy to understand. What do members need to know about these plans that they probably don't? Carry your membership card with you at all times. Make a copy. It will save a huge amount of hassle if you have an unexpected doctor or hospital visit. Understand your plan's doctor and hospital network. Insurance companies negotiate participation and payment rates with a network of providers to control costs. "Many of these exchange plans, in order to stay affordable, have much smaller networks than people are used to. Just because their friend has a plan and can go to a particular hospital doesn't mean that you necessarily can too. You can check your carrier and plan's directory. Go online or sometimes part of the documents you receive when you enroll to find out if specific physicians are part of your network. You can call doctors' offices to confirm, too, but many times the doctotrs office ismn't always reliable. One thing for sure, Stay in the network! The Affordable Care Act states that, once you join a qualified plan, you won't pay more out of pocket per year than $6,350 for an individual and $12,700 for a family. This applies only to in-network care. Whether youre in an HMO that pays almost no out-of-network benefits or a PPO that covers some, the pocketbook protections don't apply if you use a non-network doc or hospital. Non-network providers also frequently bill you far more than what they charge patients in their networks for the same procedure. Try to stay in-network even if it's for emergency care. Insurance plans do have to pay for non-network emergency visits under the health law. If you're in a car crash far from home you can't choose which hospital saves your life. But non-network hospitals often "balance-bill" the difference between what your plan pays and what they charge, which is often much more. Avoid all emergency rooms unless it's really an emergency. Traditionally, health plans came with a modest copayment for an emergency visit of $100 to $200. Many policies sold under the health law, even those in the more expensive "gold" category, not only have ER copays of several hundred dollars but also subject ER charges to the overall deductible. Copays are flat fees for specific services. Deductibles are what you pay out of pocket before the insurance kicks in. That means you could be billed for the full cost of an emergency visit up to the out-of-pocket limit. This is a huge difference from traditional plans and will really hurt the an individual or family. "The new plans put a lot more people into that exposure. Broken leg, head to the hospital. Sprained ankle,maybe wait until the urgent care center or doctor's office opens. Pay monthly premiums on time and accurately. Do not wait, pay your premium; Otherwise that will be the end of your insurance and you can't sign up again until the next open season in November for a Jan 1, 2015 effective date. Open enrollment for 2014 coverage ends March 31. Open enrollment for 2015 begins Nov. 15. Even underpaying the premium by a few cents could give the insurance company grounds to kick you off, she said. Insurers allow a brief grace period if you get behind. Ssomewhat longer if you're receiving premium subsidies, but they will terminate coverage for nonpayment. Register online with your new insurance company. Insurance sites are good for tracking claims. Increasingly they also let you shop around for the best deals on non-emergency treatment. Your health plan might pay one imaging center half what it pays another imaging center. Save paperwork. Make sure you really owe what doctors and hospitals bill you for. Now is a good time to become a pack rat. If you have any concern, it really is worth it to make a call and get them to explain what they did. If you don't get satisfaction from providers or insurers, try regulators. Check the insurer's explanation of benefits detailing your claims. It may show a phone number for a consumer assistance program in your state to help deal with medical coverage. Do read the plan's summary of benefits and coverage. You might want to print it out, because that has the details of your plan, and how it works. What you have to pay in order to go to a primary care doctor? Is it before or after the deductible? How big is your deductible? How much does it cost to go to the emergency room? Remember your health is really important.