Types of Insurance

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Some health insurance plans are Affordable Care Act (ACA) compliant and some are non-compliant.

ACA compliant plans must insure all essential health benefits.

Non-ACA compliant are not mandated to provide preventive care, pharmaceuticals, mental health services, or insure pre-existing conditions. These plans do not meet the federal tax exemption mandate for US citizens.

Types of Insurance

There are a variety of health insurance types.  It is necessary to review each of these types to ensure that affordable care can be accessed in the Wheaton community, overseas, or at HoneyRock (WI).

HMO

HMOs are Health Maintenance Organizations. In general, HMOs require that the client access healthcare through the list of providers supplied by the insurance company. The client is able to access healthcare outside of the insured provider list, but insurance will not pay for any primary care needs, such as preventive visits, physical therapy, elective surgeries or diagnostic tests. Usually these plans are less expensive. They may only cover you in your home state for all services and outside of your state for emergency care.

The best way to use an HMO is by

  1. Seeing your primary care physician (PCP) first, unless it is an emergency.
  2. Get a referral from your PCP before attempting to make an appointment with a specialist.
  3. Stay in network: HMO plans only cover costs of services provided in the network.
  4. Use the Emergency Department only for emergencies. At times you may need to notify your PCP that you utilized the ED within 24 hours.

PPO

PPO means, Preferred Provider Organization plan. This is a plan in which a healthcare group is organized by an insurance company, so that medical care be offered at fixed prices or fees for in exchange for managed medical care. Individuals will have a deductible (predetermined lump sum of money) to pay out of pocket before the insurance company will begin to pay for medical care. Services are covered at a higher rate by the insurance company when contracted healthcare providers are accessed.

HSA

HSAs are health saving accounts and are designed as a tax free account established to receive monies designated for healthcare services and products approved by the United States Internal Revenue Service (IRS). Usually HSAs are coupled with a high deductible (predetermined lump sum of money that must be paid before healthcare costs are covered through the healthcare plan).

Catastrophe

Catastrophe plans are typically utilized for short term healthcare needs. They generally cover a variety of acute health care needs and are not designed for long term use or if someone has a known chronic illness. Catastrophe plans are not recognized by the Affordable Care Act mandated insurance law. However, if an individual can demonstrate an approved hardship, he/she may be able to be given an insurance Federal tax exemption for one year.

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