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Choosing Between an HMO and a PPO

Buying a health care plan, whether it is the first time or the fifth, is difficult. There are so many options out there and it can be difficult to know if you are making the right choices for your needs. For the needs of most families and individuals, the options come down to choosing between an HMO and a PPO plan, but what exactly does that mean?

What are HMO and PPO Plans?

HMO, or Health Maintenance Organization plan, is when you choose your primary care physician from within the specified network of doctors. HMO plans give you access to only certain hospitals and doctors that have agreed to lower rates for the insurance company and their members on the plan. While this often sounds pretty great, often an HMO will not cover any out-of-network care unless it is a true emergency. With HMO plans, you need to keep in mind that there may be a number of restrictions such as how many visits or tests will be covered. Furthermore, you will need a referral from your primary care physician to visit specialists, but the trade off is that you face lower out of pocket costs for the plan.

Alternatively, a PPO, or Preferred Provider Organization plan means that you will still have access to a network of doctors covered by the plan, but you can still visit any other doctor or specialist that is within the network without a referral from your primary care physician. The trade off here is that you will have an annual deductible that you will need to meet before you get full coverage, and many services will still have a co-pay. In essence, this means the plan is more expensive, but it allows more freedom.

Choosing the Plan Right For You?

There are benefits and disadvantages with both plans, but you will want to choose the one that most fits your needs. Because of the lower cost and more restrictive nature of an HMO plan, it is often better to choose it for preventative care as it is also the less costly option. However, if you are chronically sick and may need a variety of treatments every year, choosing a PPO may mean better treatment at a higher expense.

If you’d like to learn more about health care insurance and the intricacies that go with much of the process, contact us today.

Understanding the Difference Between Medicare A & B

Medicare is provided by the government to provide you with assistance. Understanding what the plans offer will allow you to determine what you need and how you are covered.

Plan A

Plan A is often free for many people because they paid towards it when they were employed. Part A will cover your hospital expenses, including overnight stays in a hospital, hospice, skilled nursing care, and home healthcare services. Depending on the expense, you might have to pay deductibles or copayments.

Plan B

Plan B covers other aspects of healthcare. You will often need this because it is your general healthcare coverage. Most people will have to pay a premium for this part of Medicare. It will cover the services needed if your ill or have a condition, including doctor visits and lab work. It will also cover medical equipment that you might need, such as a wheelchair. In many instances, you will be responsible for 20% of the amount approved by Medicare.

Medicare Advantage is something to explore because it will allow you to enroll in Part A and Part B. you will then be responsible for your Part B premiums.

Beyond plans A and B, you can look at various other plans that are offered by Medicare. This will allow you to obtain more coverage so that you can take care of prescriptions, lower your deductibles, and more.

You qualify for Medicare once you turn 65. Enrollment is not automatic, so once the paperwork comes to you, it’s important to fill out the paperwork and determine what plans you want to sign up for. It could be what’s needed to provide you with low-cost healthcare.

Once you get the coverage from the government, you can then add additional Medicare plans. Learn more about this coverage by contacting National Health Insurance Agencies today.

Ways to Save on Health Insurance

Everyone needs health insurance, but having a plan doesn’t always mean your costs are covered. High deductibles can take a lot of money out of your pocket every year. Co-pays and monthly prescription expenses also add up. Here are some ways to save while still getting the care you need.

Research Costs

According to Consumer Reports, the cost of an MRI might be as much as four times higher at one imaging center than at another. Most insurers provide a tool on their website that will allow you to look up treatment prices and choose a more affordable option.

Go Generic

If you’re taking monthly prescriptions, ask your doctor if you can switch to a generic prescription rather than the name brand. Generic prescriptions will produce the same results for much less– sometimes saving you hundreds of dollars per month. In some cases, switching from prescription medications to over-the-counter medications can also be a money-saver.

Schedule Tests Wisely

If you regularly meet your deductible each year, consider tweaking your calendar to save on out-of-pocket expenses. Schedule expensive tests, specialist appointments, or procedures towards the end of the year, when you’ve already met your deductible. You’ll receive the care you need without draining your wallet more than you have to.

Read the Fine Print

Know exactly what’s in your health plan and what it covers. Learn which procedures require pre-approval, what you’ll be charged for in-network versus out-of-network care, and visits to the ER. Then, plan and prepare for your costs accordingly.

Shop Around

Do your research and compare plans to find the right one for you. If you go through the Health Insurance Marketplace, you may qualify for an income-based tax credit that will help shoulder the burden of monthly premiums. Your employer may also offer different tiers and coverage levels. Choose one that fits with your needs and covers your expected medical expenses.

At National Health Insurance Agencies, we can help you navigate health insurance plans to find the coverage you need at an affordable rate. Contact us for more information.

Getting Diabetes Testing Supplies Covered by Health Insurance

“More than 100 million U.S. adults are now living with diabetes or pre-diabetes,” according to a new report released (2017) by the Centers for Disease Control and Prevention (CDC). The report finds that, “as of 2015, 30.3 million Americans – 9.4 percent of the U.S. population –have diabetes. Another 84.1 million have pre-diabetes, a condition that if not treated often leads to type 2 diabetes within five years.” There are some indicators that show this number is starting to level off and in truth the dramatic increase in numbers may be related to the awareness of the medical community. Regular testing for the disease is now part of every patient’s routine checkup. As a result more people than ever before fit frequent glucose monitoring into their daily life.

Monitoring blood sugar is a quick and easy way to help self-manage diabetes care but though the monitors alone aren’t usually expensive the testing strips can be. Add to this the cost of lancets, alcohol wipes, finger bandages, and gauze and it can strain the average American’s budget.

Insurance Preference

In most cases health insurance plans will cover the cost of the glucose meter (or glucometer) and the necessary supplies like strips and lancets. The key is to make sure your Healthcare Provider orders the kind of machine your insurance prefers. Keep in mind that the preferred brand can change, and often does so at the beginning of the year, so be sure to ask your pharmacist if the machine and supplies are covered before you buy them. If the co-pay is still too expensive on the brand of machine your company prefers you don’t have to use that machine. There are lower priced over the counter glucose meters (or glucometers) on the market with equally affordable strips. Walmart carries its own in-store brand and other name brands that are affordable and acceptable choices.

At National Health Insurance Agencies we are here to help you navigate the insurance plans available to you to find competitive rates and great coverage. Contact us today!

Copay vs Coinsurance: Understanding Insurance Plan Keywords

A recent survey by UnitedHealthcare showed only 9% of Americans truly understood the terms of their health insurance policies. This number is up 3% from the 2016 study by PolicyGenius, but is still low enough for serious concern. When comparing policies for purchase, it is essential to fully understand the policy in order to make the best choice for yourself and your family. Here are the definitions you need to get started.

  • Premium:  Your premium is the amount you pay per month to maintain your policy. This is separate from any costs incurred via medical appointments or procedures, and it is either billed to you monthly or taken out of your paycheck if you get insurance through your employer.
  • Deductible:  This is the amount you must pay for medical services per calendar year prior to your insurance company covering anything. However, many plans have certain things they cover prior to meeting your deductible, such as preventative care (your yearly physical, for example) or medications.
  • Copay:  This is the cost you pay per visit, procedure, or medication. It is typically a flat rate, such as $20 for a doctor’s office visit, no matter the cost of the visit. The cost may vary depending on if your provider is in network or out of network.
  • Coinsurance:  This is a percentage you pay of the total cost of a procedure. The difference between copay and coinsurance is that the amount you pay when you have coinsurance due differs depending on the cost of the procedure or visit, whereas the copay is a flat rate. Coinsurance typically begins after you meet your deductible, when the company begins to pay for portions of your services.
  • In Network and Out of Network:  Your insurance company has preferred providers or a preferred local area. This is their network. Providers that are outside this network are typically more costly to see.
  • Out of Pocket Maximum:  This is total amount, per calendar year, that your insurance company expects you to cover. Your out of pocket maximum includes anything you pay for copay, coinsurance, and deductible payments. It does not include your premium. Once you hit your out of pocket maximum, your insurance company will cover 100% of your medical costs, with the exception of your premium payment.

Knowing what these terms mean can make a big difference in the policy you choose. National Health Insurance Agencies can you help choose the best plan and answer your health insurance questions. Contact us today for more information.

Why Costs Keep Rising Under The Affordable Care Act

When the Affordable Care Act was signed into law under President Barack Obama, it was touted as a cost-reducing, life-saving plan. While this was true in many aspects, many people have found that the former point has not held up. Premiums have risen in many states, drug prices continue to sky-rocket, and profiteers like Martin Shkreli reach their hands into sick people’s pocket books.

There’s a good reason for this, and unfortunately, it was a part of the ACA’s design. Cost controls have never been a part of the ACA. They were purposefully left out in a successful effort to hand over more control to health companies at the expense of the patient.

Is It Obama’s Fault?

Despite the political divide that surrounds President Obama’s marquee legislation, the truth is, the left and the right were fundamental in setting up this style of system. There’s a reason that Obamacare was known as a recreation of Romney-care: both were largely designed by the think-tank The Heritage Foundation. Though Heritage will fume when presented with claim, Politifact overwhelmingly supports it.

Health Care Is Expensive No Matter What, Right?

Whether left or right, all Americans have been taken to task by the lack of cost controls in the ACA. In Canada, where cost controls do exist, it’s possible to get the same drugs, the same surgeries, the same level of health care as Americans do, but for a fraction of the cost. This is no accident; ostensibly, premiums and costs were designed to rise under the ACA.

If you’re interested in what this means for you, contact us.

Health Insurance Does Not Have To Be So Difficult!

Did you make a trip to the hospital? Do you have a ton of bills and you don’t know why since you have insurance? You are not alone! There are a lot of adults in the United States that don’t understand insurance. Health insurance may be hard to understand, at first. The Henry J. Kaiser Family foundation tested men and women in basic health insurance information and the results are shocking. Fifty percent of females and forty-seven percent of men failed the ten question test on basic health insurance information with scores under seventy percent. That is shocking! Here are some helpful terms that may confuse people.

Some helpful health insurance terms to get yours through this policy year and the next!

  • Premiums are the amounts you pay monthly to stay covered.
  • Deductibles are the amount you have to pay before your insurance pays anything. (Hint: Check to see if your deductible payment goes toward your out-of-pocket.)
  • Out-of-pocket is the amount you need to pay to assist the insurance. (Hint: Once you pay all of your deductibles and out-of-pocket most procedures are free!)
  • Co-pay is what you pay upfront to assist the insurance. (Hint: Check your plans to see if this goes toward the deductible, out-of-pocket, both, or neither!)
  • Coinsurance is the percentage that you assist the insurance to pay when the doctor’s office charges you. (Hint: The doctor’s office can ask for payment when they see fit. This has nothing to do with your insurance company.)
  • In Network is the doctors, labs, and hospitals that have a contract with the insurance and your plan; to bring you better deals. (Hint: Never go by your friends In Network status is.)
  • Out of Network is the doctors, labs, and hospitals that do not have a contract with your insurance or plan. This means no deals and it could get expensive very fast! (Hint: Even if the hospital or doctor is In Network the labs and other doctors maybe Out of Network. Always check with your insurance)
  • Procedure codes are codes that the doctor’s office or hospital use to bill the insurance company. (Hint: Talk to the medical billing and coding specialist after the doctor makes the order to receive the procedure codes.)
  • Prior authorizations give the insurance company the opportunity to check if a procedure will be covered under your plan before the procedure happens. (Hint: You can appeal a denial decision if you feel that the plan does cover it.)

Health insurance is not that difficult! Ask your insurance company questions we are here to help. The only questions that are crazy are the ones that are never asked! You can contact us with any questions concerning your plan or future plan. We are here to help you.

Your New Medicare Card – What You Need to Know

What is happening?

  • This April, Centers for Medicare & Medicaid Services (CMS) will begin mailing new Medicare cards. You don’t need to do anything and your benefits won’t change. You can use your new card as soon as you receive it.
  • There are over 50 million people enrolled in Medicare, so the roll-out of the new card will take place over the following 12 months

Why are the cards changing?

  • The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 requires that social security numbers be removed by April 2019.
  • To reduce your risk of identity theft and illegal use of your benefits. Social security numbers tracked earnings for social security. Today, Social Security identify individuals for financial purposes. For this reason, it is good practice to keep your social security number private, and separate from your date of birth and address.

What is different?

  • Your social security number will no longer be on the card. Instead you will see a new, 11 digit number. This identifier, called a Medicare Beneficiary Identifier (MBI), is randomly generated and is not associated with your social security number.
  • Your new MBI number is confidential – protect it

Watch out for scammers already taking advantage of the new card. Remember, the new card is free and you do not need to do anything to receive it. If you receive a call about Medicare, do not share information – Medicare will not call you. If you are unsure, always hang up and call back using the number on your card.

Read this helpful article from AARP

Five Things to Get Checked as Soon as You Have Health Insurance

Has your back has been bothering you? That rash from last summer still there? If you have been without health insurance for while, you may have some health concerns that have not been tended to.

Yearly Physical

Depending on how long it has been since your last physical, even missing one can be dangerous. Physicals are vital for you to do to catch anything that can or is harming your body. Early detection involving cancer and other fatal diseases can be caught at this stage. Insurance companies usually pay the full amount, meaning no co-pay for your yearly physicals.


About 1 in 8 US women will develop invasive breast cancer over the course of her lifetime. Once you have gotten your insurance, be sure to set an initial appointment to get a mammogram.

Pap Smears

This year, an estimated 12,820 women in the United States will be diagnosed with cervical cancer. It is estimated that 4,210 deaths from the disease will occur this year. A pap smear is used to screen for cervical cancer. The assessment is usually done in combination with a pelvic exam that you could get during your yearly physical.

Prostate Cancer

Gentlemen, approximately 11.6% of men will be diagnosed with prostate cancer at some point during their lifetime. Be sure to get your prostate checked once a year by a medical professional.


If you miss cleanings and don’t go in for routine checks, bacteria can not only rot your mouth but find their way into your bloodstream, possibly resulting in death. Get a healthcare plan that includes dental; you and your loved ones will appreciate it. And contact us to let us know how we can help you get insured.

Things not Covered by Medicare

Medicare is a federal health insurance plan for those aged 65 or older to pay for hospital care and outpatient medical services. Once you reach age 65 and apply for Social Security benefits, you are also eligible for Medicare. Medicare pays for 80 percent of the cost for these services, while you are left to pay the remaining 20 percent co-pay. That 20 percent can add up to quite a large dollar amount, especially for very expensive medical procedures. For those on a limited budget, this could be financially devastating. In addition, there are some services/procedures that are not covered by Medicare. Let’s take a look at those:

Medicare Part A (Hospitalization) Exclusions to Coverage

  • Prescription Drugs (expect those administered during a hospital stay)
  • Nursing home custodial care stays
  • Medical care outside of the United States
  • Cosmetic procedures/surgery
  • Private nursing care

Medicare Part B (Outpatient Care) Exclusions to Coverage

  • Podiatry (foot care)
  • Dental exams and procedures such as fillings, extractions or dentures
  • Hearing exams/hearing aids
  • Wellness programs
  • Eye examinations/prescription eyewear
  • Prescription drugs

Medicare Supplemental Insurance is available to provide coverage for things that Medicare does not cover or to help with co-pay amounts. There are 10 different types of standardized Medicare Supplemental insurance available (Plans A-M) offering a variety of coverage options depending on your needs.

If you are on Medicare but find that Medicare does not cover your medical care adequately, you can contact us for a consultation. We have trained agents who can consult with you and find you the right policy to meet your health care needs as well as one that will fit within your financial budget. We want to help you get the medical coverage you need and deserve.