Healthcare For You and Your Family: Open Enrollment Starts November 1st

By Blanca Lopez-Franco, Licensed Health & Life Insurance Agent

Educating yourself about healthcare is the first step in keeping you and your family healthy. People without healthcare tend to avoid seeing their doctor. Regular check-ups ensure that illnesses or conditions are caught early, saving your health, time and money. If a condition is not treated, it could lead to further health damage and/or rack up costs for treatment. A huge issue is that people are just simply confused on how healthcare works.

Ready For 2020 Open Enrollment?

Open enrollment is the time period in which you choose the health care plan for the following year. It runs from November 1^st to December 15^th and all plans are effective January 1^st of the following year. There are also special enrollment periods based on different situations such as childbirth, divorce, marriage, loss of employment and relocating to a different service area. 60-day time frames are usually given to special cases such as these.

What About Premiums?

The Government provides a subsidy for qualified enrollers. You need to provide an estimated income for the following year and the number of people in your household. To qualify you need to be below the federal poverty level adjusted every year by the Federal Government. If you (or your family) make less than 138% of the federal poverty level you will qualify for Medicaid.

Documents to provide for Medicaid:

Proof of income – last year’s taxes and paystubs
Proof of citizenship
Social Security #’s for everyone in the household
When choosing the right plan, ask yourself:
Are your health providers on the network of your carrier?
How do you plan to use your healthcare plan?
How many times will your family go to the doctor?
Expecting a major surgery or procedure?

The 3 Kinds of Networks

HMO – Health maintenance organization – requires referral from a primary care physician and there are no out of network benefits
EPO – Exclusive provider organization – does not require referral from a primary care physician and there are no out of network benefits
PPO – Preferred provider organization – allows you to see any doctor in the network without a referral and has out of network benefits

Terms To Keep In Mind

Deductibles – First amount of money you will pay when you go for a service
Co-Insurance – After deductibles you will pay a portion of the service and that amount that will take you to the maximum out of pocket