Consumer Education

Consumer Education Center


See articles, FAQs, tips, and videos to help you navigate your health insurance options, special enrollment periods, and find your coverage options today. We believe an informed and educated individual is a wise health care consumer that will seek the best in quality and affordable health care services.

Video – “How will I be covered?  The You Toons Get Ready for ObamaCare”

You Toons walk through the basic changes to the ways Americans will get health insurance.

INDIVIDUAL PREMIUM TAX CREDIT SUBSIDY


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Beginning in October 2013, middle-income people under age 65, who are not eligible for coverage through their employer, Medicaid, or Medicare, can apply for tax credit subsidies available through state-based exchanges. Additionally, Arizona expanded their Medicaid programs to cover all people making up to 138% of the federal poverty
level.So if your annual income falls between 139% – 400% of the Federal Poverty Level and your insurance premium is greater than 9.5% of your household income, then you may get a subsidy.

To see if you may qualify for a subsidy, please click on the link below.

SUBSIDY CALCULATOR – CLICK HERE

NOTE: this calculator is only an estimate. To see if you actually qualify for a subsidy, you must apply through one of our licensed, personal agents (1-855-634-9321) or the Federally Maintained Marketplace.

INDIVIDUAL BENEFIT COST SHARING


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In addition to premium tax credits, benefit cost sharing subsidies are also available for people who make between 100% and 250% of the poverty level. Benefit Cost sharing subsidies further limit out of pocket costs and raise the actuarial value of Silver plans. In most cases, Silver plans have an actuarial value of 70 percent. However, for people with incomes between 100% and 250% of the poverty level, the actuarial value of Silver plans will range from 94% to 73%. Cost-sharing subsidies are only available if the eligible person enrolls in a Silver level plan. To see if you actually qualify for Benefit Cost Sharing, you must apply through one of our licensed, personal agents (1-855-634-9321) or the Federally Maintained Marketplace.

To see if you actually qualify for Benefit Cost Sharing, you must apply through one of our licensed, personal agents (1-855-634-9321) or the Federally Maintained Marketplace.

Individual Health Plan Options


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  1. Preferred Provider Organization (PPO)
    1. Large National network
    2. No need to designate a Primary Care Physician
    3. You manage your healthcare – no referral needed – go directly to a specialist
    4. You can see who you want, however, out of network provider costs will be higher
  2. Health Savings Account (H.S.A.) Plans
    1. Advantages of a PPO, but no copays
    2. Large National Network
    3. You pay discounted rates up to the deductible amount, then your coinsurance amount kicks in up to the out of pocket maximum of the plan
    4. Can open a personal Health Savings Account which gives you pre-tax advantages on your contributions
    5. Your money – if you don’t use what you put in, it rolls from year to year.Learn more on how to be a wise H.S.A. health care consumer
      – See Consumer Education & Tools page.
  3. Health Maintenance Organization (HMO)/ Accountable Care Organization (ACO)
    1. You designate a Primary Care Physician
    2. Must get a referral from PCP to see a specialist
    3. Services outside of network are not covered
    4. Smaller, efficient provider networks with plan cost up to 20% less
  4. $4 Rx List – Target and WalmartTake advantage of $4 Generic Prescription Lists whether you have insurance or not. Check the list to see if your prescription is an approved generic. You do not need to show the pharmacist your health insurance ID card, it is not necessary when filling $4 RX listed medications which is part of the retailers pharmacy program. 4 Rx list.pdf

Individual Health Insurance Open-Enrollment


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Health insurance can only be applied for and obtained annually through the enrollment window of November 15th – February 15th. If you, and your family, do not have health insurance coverage in place during the tax year, you will be subject to penalties. There are a few events that will allow individuals and their dependents to enroll outside of the annual open-enrollment window. See below.

Individual Qualifying Events for Special Enrollment Period (Outside of open enrollment 11/15/14-2/15/2015)


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    Loss of coverage
  • Annual renewal occurs outside of Open Enrollment
  • Divorce or Legal Separation
  • Reduction in hours – Full time down to Part time
  • Group coverage terminates
  • COBRA benefits end
  • Turn 26 and no longer qualify as a dependent
  • Short-term medical expires
  • Spouse’s employment ends and so does the coverage
  • No longer eligible for CHIP or AHCCCS (Medicaid)
  • Terminated from your employment and your coverage ends
    • Additional documentation will be required for special enrollment events along with the enrollment forms

PROVIDER NETWORK SUMMARY AND LISTINGS


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Frequently Asked Questions
Individual and Business


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HSA INFORMATION AND TOOLS


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Fair Health Consumer


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FAIR Health is a national independent, not-for-profit corporation whose mission is to bring transparency to healthcare costs and health insurance information through comprehensive data products and consumer resources. FAIR Health uses its database of billions of billed medical and dental services to power a free website that enables consumers to estimate and plan their medical and dental expenditures. The website also offers clear, unbiased educational articles and videos about the healthcare insurance reimbursement system.
Cost Transparency + Education + Videos

  • Health Plan Options (scroll below)
  • Advantages – Disadvantages PPO/HMO/ACO
  • Provider Network SummaryKnow your Provider Network and Hospital listing BEFORE YOU BUY! – Individual, Small Groups, and Mid/Large Size Groups, have different Hospital and Doctor network affiliations. Make sure your doctor is part of the Network! Smaller networks will save you up to 20% less in your premiums but you will have less doctors and hospitals to choose from. Be especially careful when you live in outlying rural areas.

HOW IT WORKS

The Fair Health Fee Estimator provides access to data contained in a database of billions of billed services in 491 distinct geographic areas across the U.S., ensuring that data are relevant to local practices and those operating in multiple regions. Charges in the database are an aggregation of non-discounted fees-for-service as reported by healthcare professionals on claims submitted to private insurers, and include claims from private insurance plans representing over 125 million participants. FH Fee Estimator data are continually refreshed on a rolling 12-month basis.

Based on a database of over 16 billion non-discounted fees billed by healthcare professionals for thousands of medical and dental procedure codes, the FH Fee estimator provides benchmark charges by specialty and geographic area.

Information On

  • What do the terms in my EOB mean?
  • What is the difference between an HMO, a PPO, a POS, and an EPO?
  • What are the differences between in-network and out-of-network care, and how can those differences affect me?
  • How do health plans typically share costs with their members? (e.g. what are the differences between co-pays, co-insurance, deductibles, and out-of-pocket maximums)?

Through efforts like these, FAIR Health seeks to help de-mystify the landscape of the healthcare system for the benefit of all consumers. FH Reimbursement 101 is just one part of the “curriculum,” and we look forward to introducing more important healthcare consumer innovations.

VIDEOS FOR CONSUMERS

User Friendly Guide of Videos – click here
Fair Health Reimbursement 101 Videos addresses a range of topics including:

  • Cost Sharing – Know what you owe!
  • Out-of-Network Doctors at In-Network Hospitals
  • Alphabet Soup of Plans (HMO,PPO,ACO,HDHP,H.S.A….)
  • Understand your EOB (Explanation of Benefits)
  • What is the difference between emergency care and urgent care?
  • Why is it possible to be billed for an out-of-network provider at an in-network facility?
  • What are the most common type of dental plans?
  • What does it mean to use Medicare fees as a basis to determine out-of-network care?
  • What is a Flexible Spending Plan, and how does the federal healthcare reform bill impact such plans?
  • What is a modifier on a claim form and how may it impact your level of reimbursement for out-of-network services?
  • What is the difference between an insured and self-insured plan?
  • How do health plans establish their networks?
  • How do I appeal a reimbursement decision?
  • Questions should you ask your Insurance Plan before going out-of-network?
  • Questions should you ask your Provider?
  • Understanding Anesthesia Reimbursement
  • Understanding High Deductible Health Plans

Tele-Medicine- Health Now MD


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The Wave Of The Future
It may surprise you that approximately 78% of doctor visits could be handled by phone, email, or video conference. This kind of medical service is known as telemedicine. A few other statistics:

  • Approximately 91% of telemedicine consultations result in a satisfactory resolution with no further action needed
  • Telemedicine doctors spend an average 14 minutes per patient, compared with an average of 4 minutes in the doctor’s office
  • Patient satisfaction with telemedicine averages 97% compared with just 67% for traditional doctor visits
    Until now, telemedicine was reserved for a few people on expensive private plans.
    Now everyone can share in this exciting breakthrough; thanks to Health Now MD.More information see flyer HealthNowMD Print application and send direct to Cambridge Benefit Solutions for processing. Health Now Application

Good Rx


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Stop paying too much for your prescriptions! Compare prices and find coupons to save up to 80%!

Drug prices are different at every pharmacy.

How Good Rx helps:

  • Compare prices for all FDA-approved prescription drugs at virtually every pharmacy in America.
  • Find pharmacy coupons, manufacturer discounts, generics, comparable drug choices and savings tips all in one place.
  • Save up to 80% at local pharmacies you already know. We’ll even send you refill reminders and alerts when prices change!
  • Got insurance?Good Rx can often beat your co-pay or help with drugs that aren’t covered by your plan.

 

 


Good Rx.com