Whether you are looking for the best health insurance agency in Chicago or you are interested in buying a plan from a different state, there are a few things you should consider before deciding on a plan. These include whether to work with a broker or an agent, the differences between Point of service (POS) plans and Exclusive Provider Organization (EPO) plans, and the benefits of Medicaid and Medicare.
Broker vs agent
Using a broker to purchase health insurance can be a good idea. They can help you determine which plan is right for you and provide a bit of back up. They can also ensure you have access to doctors and hospitals. It is best to find a local broker who knows your area.
In general, agents and brokers do the same things, but in different ways. A broker will be able to shop around for the best rates. They may also have the ability to bind coverage. They will also have the opportunity to provide you with some excellent advice. A broker can also show you how to better manage your risk.
A broker may also have the opportunity to earn a bonus from a broker agency. These bonuses can influence the advice they give you. A good broker will be able to demonstrate the best solution to your insurance needs without disrupting their revenue stream.
Point of service (POS) plans vs Exclusive Provider Organization (EPO) plans
Whether you’re looking for a new health insurance plan or switching from your current plan, you’ll need to decide between Point of service (POS) plans vs Exclusive Provider Organization (EPO) plans. Both of these managed care plans offer a variety of benefits, but the cost can vary greatly.
Both PPOs and EPOs are health insurance plans that provide basic medical treatment and cover preventative care, long-term and specialist treatments, and emergencies. However, POS and EPO plans can differ in how much they cover for out-of-network services.
While PPOs can be less expensive than EPOs, you’ll likely pay higher deductibles and out-of-pocket costs. You should check with your health insurance company before signing up for a PPO to ensure that you’re covered for out-of-network care.
Some people prefer EPOs because they don’t have to get referrals from their primary care physician to see a specialist. The main benefit of an EPO is that you can choose a doctor of your choice from the EPO’s network. This means that you can develop a relationship with a doctor you prefer.
In-network doctors negotiate lower rates
Several health insurance companies are negotiating lower rates with in-network doctors in Chicago. But the process of negotiating a contract can be confusing. It’s important to know what you’re getting into before you begin a negotiation. It can help to have an experienced health care attorney on your side to remove the burden of negotiating.
The Affordable Care Act creates a new federal rule to protect consumers from surprise medical bills. This will apply to about 10 million surprise bills a year. The No Surprises Act (NSA) establishes a process for determining the payment amount for these unexpected medical bills.
Another way the NSA protects consumers is by limiting how much hospitals can bill patients for out-of-network services. Under the NSA, hospitals cannot bill more than the cost sharing amount paid by the patient’s insurance company.
One study from Avalere Health determined that contracts between health insurers and physician groups could directly impact a QPA, or quality payment average. The Peterson-KFF study found that surprise medical bills occur in between nine and 16 percent of in-network hospitalizations for non-emergency care.
Medicaid and Medicare provide healthcare coverage in Illinois
Whether you are looking for healthcare coverage in Illinois or elsewhere, Medicaid and Medicare are two programs that work together to help those who have limited resources. These programs are federally and state-run, and each state sets its own eligibility criteria.
Both programs help people with disabilities and low incomes obtain medical care, but they have different cost-sharing. For example, Medicaid covers hospital stays, x-rays, prescription drugs, and other services. However, Medicare does not cover certain services. These include long-term care, medical supplies, personal care, and family planning.
In June 2014, the Affordable Care Act (ACA) expanded Medicaid to more people in Illinois. In the first several months, 350,000 new enrollees were approved. In August 2016, the total number of enrolled Illinoisans was more than 646,000.
According to the Department of Health and Family Services, most enrolled Illinoisans are in the traditional Medicaid groups. These are pregnant women, seniors, children, and disabled people.
