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Do you speak health insurance Okie style? National Public Radio and Kaiser Family
Foundation recently published stories stating how most people just don’t
understand the terms of Health Insurance.
Understandably so since most of terms and acronyms used in ObamaCare
lingo are not a part of our everyday conversation. You may have heard Cost
Share Reduction (CSR), Maximum Out of Pocket (MOP) or Federal Poverty Level
(FPL) to name a few. We have explained
all of these terms in our easy to understand ObamaCare Survival Guide.
There is also the Insurance Company terminology that
explains their plans and networks. I thought I would expound on that further
today as knowing the differences can greatly affect you healthcare options and
your wallet. Blue Cross has multiple
network plans with a HUGE difference in price and benefits. Unfortunately when you run a quote you only
see the words Advantage, Preferred and Multi-State with no explanation of what
they mean. For everyone who has gone to
our website recently this is something I’ve tried to simplify by adding videos
right next to the quotes that explain the differences in the plans. For everyone else, we have this blog.
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Blue Cross and Blue Shield Plans:
ADVANTAGE – Blue
Advantage is the less expensive Blue Cross health plan, it has the most
benefits before you meet your deductible. The Advantage Network is a
smaller network with most of the Hospitals and Doctors having some type of
relationship with Mercy or Saint Anthony's Hospital. The only way to know
if your Doctor is in this plan is to check the network and see if he is on the
Advantage plan.
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PREFERRED - Blue Preferred is the more expensive, larger network with very limited benefits available before you meet your deductible. The Blue Preferred Network has the Integris / Baptist Hospitals, OU Hospitals plus has recently added the Duncan Regional and Norman Regional Hospitals to the Network. MULTI-STATE – Multi-State is the same network as the Preferred in 2016. That is a big change since the last 2 years Multi State has had a much larger Network.
UHC or United Healthcare Plans
United Healthcare has come to
Oklahoma this year with their plans priced snugly between the Blue Advantage
and the Blue Preferred Networks. The United Healthcare plan here in
Oklahoma seems to include almost all of the Hospitals in Oklahoma. Wow
that seems too good to be true...right? Well there are some trade-offs.
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1. Right between Advantage and Preferred prices is still a huge premium especially if you do not receive a subsidy from the Government. 2. UHC is an HMO… In our Survival Guide I talk about the difference between an HMO and a PPO but I will go over it briefly here too. HMO or Health Maintenance Organization vs. PPO or Preferred Provider Organization These plans are completely different in how they started and how they are regulated. As many other things like political parties the plans in the middle are closer to being the same than ever before. However differences still remain in an HMO you have to have your care referred by your primary care doctor or a website. With an HMO you have no benefits if you receive treatment out of network. The exception usually is life threatening. PPOs do not require referrals and treatment out of network is paid at a lower percentage.
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