By Pam Deaton, PD Benefits
Understanding health insurance is confusing and complicated for most people. If you don’t have any medical issues and you have health insurance through your employer, it may be quite simple: check the box, turn in the form, show your card at the doctor’s office, pony up for a co-pay, and that’s that. But if you have a chronic condition, experience a medical emergency, find that you need surgery, or any number of other situations, health insurance often becomes a frustrating cycle of navigating phone prompts, wrangling with benefits, sorting out the mountain of claims, and—once you actually reach a live human—trying to understand what they are saying!
Part of what makes health insurance difficult to understand are all the acronyms that are commonly used—COBRA, HMO, PPO, HSA, PCP, ACA, FSA, EOB, EMR, and the list goes on. Unless you are an insurance professional, this alphabet soup makes no sense at all. Let’s help clear up some of the confusion by explaining what some of these acronyms mean.
- COBRA stands for Consolidated Omnibus Budget Reconciliation Act of 1985. This is federal legislation that allows you—if you work for an insured employer group of 20 or more employee—to continue to purchase health insurance for up to 18 months if you lose your job, or your employer-sponsored coverage is otherwise terminated.
- HSA is a Health Savings Account. An HSA combines high deductible health insurance with a tax-favored savings account. Money in the savings account helps pay the deductible. Once the deductible is met, the insurance starts paying. Money left in the savings account earns interest and is yours to keep. There is no “use it or lose it” restriction with an HSA.
- HMO stand for Health Maintenance Organization. These are managed care plans that provide care for enrollees by contracting with specific health care providers to provide specified benefits. Many HMOs require enrollees to see a primary care physician (PCP) chosen by the member who will refer them to a specialist if deemed necessary. HMO plans often do not include deductibles, but copays are charged per office. HMO plans typically allow a member to have lower out-of-pocket healthcare costs, but require the member to forego some choice and flexibility with regard to selecting physicians and hospitals. Additionally, HMOs do not cover non-emergent services received from providers outside the network. HMOs do not require members to submit claims to the insurance carrier.
- PPO is a Preferred Provider Organization. As a member of a PPO, you will seek treatment from an approved network of providers, or you can see healthcare providers outside the network. These healthcare providers have been contracted by the insurance company to provide services at a discounted rate. Normally you can see any doctor or specialist within the network at your discretion, and will not be required to select a PCP. Usually, you will pay a small copay and satisfy a deductible before benefits are paid. If you go outside the PPO network for healthcare services, your share of the bill will be higher.
The insurance maze of confusion is one reason why it is a smart move to work with a dedicated health insurance agent. You might not be able to completely eliminate the red-tape, but you’ll have a go-to person for all things insurance—from choosing the best plan, to explaining the terms, to having a real person that can guide you through any glitches.
Think of me, Pam Deaton, as that savvy friend who just gets all this health insurance stuff that can seem like gibberish at times. I’ve been around the block, knowing the ins and outs of the Health Marketplace, so I can hook you up with the perfect plan that fits just right for you and your family—no more head-scratching over complex policies or shelling out cash for things you don’t really need. It’s like having a personal shopper, but for your health coverage.
And I’m with you for the long haul, not just for the signup bit. Think of me as your health insurance BFF, always on standby to chat, clear up confusion, and make sure you’re set for whatever life throws your way. It’s not just about getting you into a plan; it’s about giving you peace of mind and a real human connection. After all, navigating health coverage is a lot more fun when you’ve got a buddy in your corner.
For information on any health insurance, including Medicare, call Pam Deaton at 309-287-3518 or visit her online at www.pamdeaton.com. PD Benefits is located at 202 South Eldorado Road, Suite B2, in Bloomington, Illinois. There is no charge for Pam’s services. She works with many different insurance companies to help you review all your options and select the right insurance solution for your budget and specific family needs.