What do you need to consider when you are selecting health
insurance through the affordable care act insurance exchange
(or most any insurance open enrollment)?
Is it a PPO plan, so you can go to any provider or specialist you prefer?
HMO insurance plans have a stable of providers they refer you to. These are the only providers you can use your benefits for. When you want to choose the provider/specialist who is best suited to your needs, a PPO plan will provide you with that flexibility. PPO plans have lists of preferred providers and most also allow you to go Out-of-Network to use the provider of your choice. Your reimbursement for an Out-of-Network provider will usually be less than if you use one of your plan's preferred providers, but it can substantially reduce your total out-of-pocket costs while you see the care that best suits your needs.
Compare the benefits for Mental Health Care.
Don't just be seduced into a lower premium without fully understanding this important coverage. If you plan on using your benefits, it can make better financial sense to have superior Mental Health coverage rather than going for the least expensive premium.
What's the rate of reimbursement for Out-of-Network Providers?
Rates of reimbursement vary from plan to plan. Frankly, rates of reimbursement for Out-of-Network Providers wasn't readily apparent to me when I looked through the plan options on CoveredCA.org If this important to you, try and contact the Plan Provideror contact one of your local ACA agents to answer your questions.
Is there a separate Out-of-Network deductible?
It's uncommon, in my experiences, but you want to avoid unpleasant surprises later and be fully informed now.
Do you income qualify for price adjustments? Many people do!
This feature is part of what makes the Affordable Care Act affordable.
HMO insurance plans have a stable of providers they refer you to. These are the only providers you can use your benefits for. When you want to choose the provider/specialist who is best suited to your needs, a PPO plan will provide you with that flexibility. PPO plans have lists of preferred providers and most also allow you to go Out-of-Network to use the provider of your choice. Your reimbursement for an Out-of-Network provider will usually be less than if you use one of your plan's preferred providers, but it can substantially reduce your total out-of-pocket costs while you see the care that best suits your needs.
Compare the benefits for Mental Health Care.
Don't just be seduced into a lower premium without fully understanding this important coverage. If you plan on using your benefits, it can make better financial sense to have superior Mental Health coverage rather than going for the least expensive premium.
What's the rate of reimbursement for Out-of-Network Providers?
Rates of reimbursement vary from plan to plan. Frankly, rates of reimbursement for Out-of-Network Providers wasn't readily apparent to me when I looked through the plan options on CoveredCA.org If this important to you, try and contact the Plan Provideror contact one of your local ACA agents to answer your questions.
Is there a separate Out-of-Network deductible?
It's uncommon, in my experiences, but you want to avoid unpleasant surprises later and be fully informed now.
Do you income qualify for price adjustments? Many people do!
This feature is part of what makes the Affordable Care Act affordable.
Remember, PPO Insurance Will Give You The Most Flexibility.
There are some therapists your HMO will almost never pay for, because they are not part of their provider pool. Many therapists, including myself, who have invested heavily in developing their specialties, are Out-of-Network Providers. You won't be able to use your HMO to see them, so factor that in as you make your decisions.
Of Course, You Can See Myself Or Any Therapist Without Utilizing Your Insurance Or Seeking Reimbursements.
Many of my clients have HMO insurance, which will not help them reduce their expenses for therapy with an Out of Network (OON) therapist, such as myself. Still, they choose to work with me, because of my specialties. Specialties such as Somatic Experiencing are difficult to find on insurance panels. Occasionally, clients will elect not to utilize their PPO benefits out of a concern for confidentiality.
VICTORIA WALLACE SCHLICHT, MA, LMFT, SEP
[email protected]
1151 Dove Street, Ste. 285, Newport Beach, CA 92660
714.914.5565
"MAY YOU BE WELL.
MAY YOU BE HAPPY.
MAY YOU BE FREE OF SUFFERING."
~TIBETAN HEART MEDITATION
[email protected]
1151 Dove Street, Ste. 285, Newport Beach, CA 92660
714.914.5565
"MAY YOU BE WELL.
MAY YOU BE HAPPY.
MAY YOU BE FREE OF SUFFERING."
~TIBETAN HEART MEDITATION