THURSDAY, NOVEMBER 20, 2014
We're starting on Year 2 of Obamacare and I think it's safe to to say EVERYONE in the United States learned something new and shocking about the changing nature of health insurance. It was certainly an eye opener for many and I believe will continue to be so even in this second year. Read on to find out the biggest surprise that many experienced when navigating healthcare.gov on their own and solutions to the problem.
The biggest problem we've seen and you need to know about- your plan doesn't include your doctor or even a local hospital
The biggest issue from Year 1 we ran into actually came from people who hopped onto healthcare.gov and blindly picked a plan without doing any research.
I've received MANY phone calls and they all basically went like this:
"I signed up for health insurance at healthcare.gov. I just now realized the plan I chose doesn't include my doctor or local hospital."
THIS is one of the great failings of healthcare.gov.- lack of provider network information, whether in a list or via a link to a directory.
I've helped many people enroll in a health insurance plan via helthcare.gov and not once do I remember seeing provider network information. To be fair, perhaps this has changed for 2015 (I sincerely hope so), but until open enrollment begins, I won't know the answer.
Why Is This Such a Big Problem? Because Your Plan Will End Up Costing You More Money Than You Expected
Health insurance plans include both in-network and out-of-network deductibles and in-network and out-of-network out-of-pocket maximums.
And out-of-network deductibles are usually two or three times the in-network deductible. This is no different than before the implementation of Obamacare.
But did you know that many out-of-pocket maximums are UNLIMITED?
Here's an example of how that would work:
You have a surgery at your local hospital that is out-of-network. Let's also say that the doctors (surgeon, anesthesiologist) are also out-of-network. The total bill is $65,000. You have a $2,000 in-network deductible that doubles to $4,000 for out-of-network. You're also responsible for paying 50% of the remaining charges, where if it was in-network you would have only been responsible for $20%.
AND because the out of pocket maximum is umlimited you pay that 50% until the bill is paid (which if it was in-network, the total amount out of your would have been the $2,000 deductible + 20% of the next $5,000 in charges).
The final math:
In-network charges- $2,000 + $1,000 (.20 x $5,000) = $3,000. After you subtract the deductible from $65,000, you're left with $63,000. You're only responsible for the next $5,000 (out-of-pocket maximum) in charges after the deductible. The insurance company pays the rest.
Out-of-network charges- $4,000 + $30,500 (.50 x $61,000) = $34,500. After you subtract the deductible from $65,000, you're left with $61,000. Since the out-of-pocket maximum is UNLIMITED, you're on the hook. If you keep having out-of-network claims, you keep paying. It never ends.
Pretty devastating discovery wouldn't you say?
Your solution? Check the provider network BEFORE you purchase health insurance- Here's 2 Ways
1) Call the Ohio Department of Insurance and ask for a list of health insurance companies that are selling plans in the Marketplace. They have a consumer hotline- 800-686-1526. You can also visit the FAQ section on their website and scroll down to #6 on the list- http://www.insurance.ohio.gov/Consumer/Pages/FederalHealthReformFAQs.aspx#one. I'm not sure if the information has been updated for 2015, so to be extra safe, I would contact the Dept. for verification. They can tell you who is still offering plans.
2) Use an Affordable Care Act certified insurance agent (wink, wink)
We are certified and have helped lots of people research plans, double check provider networks and get enrolled, with little fuss and stress. Our process is set up to help you get a plan that will work for YOU and get enrolled quickly and easily. There is no additional premium for using an agent and in fact, will help you avoid the problem we've been discussing in this article. And isn't Obamacare confusing and frustrating enough? Let the specialists handle it so you can focus on what you're good at.
Open enrollment begins November 15 and lasts through February 15. Don't go it alone- Contact Alan Galvez Insurance at 937-592-4871 to talk with our Obamacare specialists.
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