Government Insurance

Depending on who you are, where you live, your status, and income, you may be eligible for government insurance. The Patient Protection and Affordable Care Act, commonly referred to as Obamacare, refers to a kind of regulated marketplace where insurance plans are sold to the general public. For most people today, insurance coverage is now mandatory, and the Obamacare plans are what people must choose if they are not otherwise covered by another plan.

The federal government also offers three other insurance-type plans for eligible people: Medicare, Medicaid, and CHIP.

Medicare has been around since 1966, and is a form of insurance offered to anyone over the age of 65. Although Medicare is administered through the government, the actual coverage is provided through a network of about 30 private companies. Medicare is further subdivided into four categories: A, B, C, and D, which refer to which kinds of healthcare are provided.

Medicaid is a form of government health insurance that is available for people with very low incomes, or who qualify due to other circumstances like disabilities or being a pregnant woman. Unlike Medicare, Medicaid is jointly administered and funded by both the federal government and the state government where the person resides.

CHIP (Children’s Health Insurance Plan) is a form of insurance coverage offered to otherwise uninsured children, and to families with otherwise uninsured children. Formerly administered at the state level, since 1997, CHIP is now a jointly operated federal and state program similar to Medicaid.

There are strict rules about when, and for how long, a person can enroll in or be eligible for government insurance plans.

Commercial Insurance

Any kind of insurance coverage not offered or administered by the government is a form of commercial insurance. Private, for-profit companies sell these plans to eligible customers for a monthly fee known as a premium. Generally speaking, most commercial insurance plans fall into the following categories:

• HMO – Healthcare is coordinated through a primary care physician, and treatment centers and providers are grouped into a network.
• PPO – The customer chooses where to get treatment, with treatment inside the network being significantly cheaper than treatment received outside the network.
• EPO – The customer chooses where to get treatment, but usually has to pay full price (out of pocket) for any treatment received outside the coverage network.

Most commercial insurance plans can be bought at any time, and a person can opt out of continuing coverage whenever they want.

The post Commercial and Government Health Insurance appeared first on SmartChoiceMD.

What is HMO insurance?

Starting in the 1970s, the Health Maintenance Organization (HMO) began offering health coverage based on an in-house network of providers.

Essentially, what makes an HMO unique is that you start by choosing a primary care physician (PCP), usually a general practitioner. Everything else, outside of emergencies, goes through that doctor. For instance, if you develop a rash, first you visit your PCP and then get a referral to an in-network dermatologist.

With most HMO plans, health services for women such as a visit to the obstetrician or gynecologist is also provided without first needing to get a referral from your PCP.

HMO plans are usually the most comprehensive insurance plans today, as your doctor has a wider range of care specialists to which you can be referred for treatment. In general, HMO plans have a higher premium than EPO or PPO plans, but are quite popular because all of your healthcare is coordinated through a single individual.

Approximately 40% of insurance plans today are HMOs.

The post Understanding HMO, PPO and EPO appeared first on SmartChoiceMD.