Our Story and More

What is COBRA?

Our featured video today is on COBRA. Our featured video today is on COBRA. Please watch the video at healthcarenavigation.com/videos. COBRA stands for the Consolidated Omnibus Budget Reconciliation ACT of 1985. COBRA is the temporary extension of group coverage at an individual’s expense (unless the employer has agreed to subsidize the COBRA for some length of time). The purpose of the COBRA legislation was to provide a temporary safety net so that coverage could be extended for

Our Story and More

The Out-of-Pocket Maximum

The Out-of-Pocket Maximum The out-of-pocket maximum is just what you’d expect from the name. It is the maximum of what you spend out-of-YOUR-pocket on the deductible, coinsurance and copayments (but not premiums or premium contributions). Once you reach the out-of-pocket maximum, the insurer pays 100% for in-network services for the rest of the year or benefit period. For non-Medicare plans, the out-of-pocket maximum is a combination of what you spend at the pharmacy and on medical services. For Medicare, medical and

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The Rules of Your Plan

The Rules of Your Plan Today’s featured topic is about the rules of one’s Plan. Please watch the video at healthcarenavigation.com/videos and spread the word so that others learn about this important topic. All coverage has rules one must follow in order for claims to be paid. The more restrictive plans have more rules so be particularly mindful of them if you are enrolled in an HMO or EPO product. The following are rules to understand: Primary Care Physician (PCP): Know

In Network Out of Network

Out of Network Benefits

Out-of-Network Benefits Today, we feature the Out-of-Network Benefits video found at healthcarenavigation.com/videos. The out-of-network benefit is sought after but poorly understood. This results in many individuals having substantial out-of-pocket exposure they didn’t expect because out-of-network providers do not have a participation agreement with their insurer. Of the U.S. healthcare system’s many disappointments, the administration of the out-of-network benefit is one of the most egregious. Most of the difficulty stems from consumers thinking their coinsurance amount (the percentage the patient

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The Network

The Network Today, we are highlighting the importance of understanding your health insurance network. The video on The Network can be viewed at healthcarenavigation.com/videos. Almost EVERYONE covered through an employer, union, individual or Medicare Advantage Plan has a network of providers. Network providers have contracted with your insurer to abide by the insurer’s rules and to accept the insurer’s negotiated rates. If avoiding unexpected medical bills is important to you, then you must understand your network. When

Our Story and More

The Product

The Product Your health insurance benefits are provided through an insurance company that offers various products (watch our video at healthcarenavigation.com/videos) with different parameters (referred to as “Plan design”), packaged in an annoying array of abbreviations which are unintelligible to most consumers. Was it always this way? No, this is a modern phenomenon associated with the evolution of health insurance. Health insurance is a vital protection but the existence of health insurance also drives up healthcare

Our Story and More

Our Story and More

Our Story and More We are delighted to announce that the “Our Story” video explaining our services and history is now available at healthcarenavigation.com/videos. And now, on with the “Health Insurance Basics” series. Copayments and Coinsurance As mentioned in our first Health Insurance Basics article, the deductible is the amount the insured pays for covered services before the insurance company is obligated to pay. The out-of-pocket maximum (our last video in the Basics series)

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Open Enrollment is Over – Or is it?

Open Enrollment is Over – Or is it?   The federal government’s marketplace, healthcare.gov, is where millions of Americans shop for individual health coverage. The open enrollment deadline for applying for coverage through healthcare.gov was December 15th for a January 1st, 2021 effective date. BUT – a number of states have their own marketplaces with later deadlines for buying coverage directly with a health insurer or through the state-based marketplace or exchange. New York, New Jersey, and California residents

Healthcare Navigation Healthcare Consultants COBRA

Loss of Subsidized COBRA — A Special Enrollment Period?

Loss of Subsidized COBRA — A Special Enrollment Period?   A Special Enrollment Period allows someone to change healthcare coverage outside of a normal enrollment cycle. In the individual market, when the reforms of the Affordable Care Act took effect in 2014, if one elected COBRA (temporary extension of group coverage) they were locked into the COBRA coverage until the next annual open enrollment period or until the end of COBRA. We recently learned that several years later, states served by the