health plans ohio

Medicare Ohio Health Plans To Consider When Shopping Around

Medicare Health Programs are another way to cover Medicare Part A and Part B. Sometimes referred to as “Part C” or “MA Plans”, they have to comply with regulations provided by Medicare-approved private companies. A lot of Medicare Ohio health care programs include Drug Coverage (Part D). In most cases, you will need to use a healthcare provider involved in local and regional network services at a very low cost.

 These plans not only reduce the cost you pay annually for the services but you can also avoid unexpected expenses with it. Some of the Medicare Ohio health plans provide out-of-network services but the cost of those services is higher. Keep your red, white, and green Medicare Ohio cards in a safe place as you will need them when you return to the original Medicare. Following are some common types of Medicare Ohio health plans that you must consider when looking for health plans

  • Health Management Organization (HMO) Program
  • Provider Organization (PPO) Program
  • Private Fee Service (PFFS) Program
  • Special Needs Program (SNP)

Here are some uncommon types of Medicare Advantage plans you can find:

  • HMO Point of Service (HMO-POS) Program
  • Medicare Medical Savings (MSA) Account System

Health Organization (HMO)

For HMO programs, you usually need to obtain your care and services from network providers, without the facility of:

  • Emergency care
  • Emergency care outside the area
  • Dialysis outside the area

Some of the health care providers might not provide some of the network services too. However, it usually costs less if you divert your attention from the provider outside the network. This is known as HMO with Point-of-Service (POS) option.

Are there prescription drugs in Health Management Agency (HMO) programs?

In many cases, HMO programs include prescription drugs. Ask the program providers. If you are looking for Medicare drug coverage (Part D), you must join the HMO program that provides access to prescription drugs.

Preferred Provider Organization (PPO)

PPO is a kind of Medicare Advantage Program (Part C) that can be availed through a private insurance company. The services under PPO include physicians, hospitals, and other health care providers. You are charged less if you utilize network services and you will be charged higher for utilizing services outside the network. 

You can avail health care services from different providers in PPO programs or hospitals. You can also receive out-of-network services for higher costs than the services provided within the network. 

Are prescription drugs included?

In many cases, prescription drugs are included in PPO programs. Ask the program. If you are looking for a drug prescription in Medicare, you must enroll in a PPO program that provides medical coverage. Remember, if you join a PPO program that does not offer prescription offer drugs, you will not join the Medicare Drug (Part D) program.

Private Financing Schemes (PFFS)

How PFFS programs work

A variant of the Medicare Advantage Plan (Part C), PFFS programs are not similar to Medigap and Medicare. Through this plan, you can determine how much cost you will be charged for different medical health facilities. 

Is it possible to utilize another hospital, doctor, or healthcare provider for medical help? 

Healthcare services from a doctor, hospital or any other healthcare provider are provided in most cases in PFFS programs. If you join a PFFS program offline, you can check with any network provider who regularly agrees to deal with program members. You can also choose a doctor, hospital, or another non-network provider that accepts the terms of the program, but your costs are usually lower when you are on the network.

 

Special Needs Programs (SNPs)

How Medicare SNPs work

A Medicare SNP is a type of Medicare Health program (such as an HMO or PPO). Medicare SNPs reduce membership in people with certain diseases or symptoms. Medicare SNPs organize all their resources together to serve a specific group with specific needs.

 

Is it possible to utilize another hospital, doctor, or healthcare provider for medical help? 

You can usually get all the services provided by the doctors and health care providers under the SNP health plan, except:

  • Emergency care in case you need immediate medical attention as a result of a sudden medical emergency.
  • If you are a renal failure patient and require out-of-network dialysis treatment. 

Medicare SNPs usually have a panel of professionals that have specialization in the condition or disease of the group allocated. 

 

Are prescription medications included?

All SNPs must provide medical treatment. In most cases, you may need a primary care physician for SNPs or you might need a caretaker to take care of your health necessities.

 

Do I need referrals to get an appointment with a professional doctor?

Referrals are needed in most cases to get an appointment with experts on SNPs. Some services do not require a transfer, namely:

  • Annual memory test
  • In-network POP testing and pelvic examination (covered at least annually)

 

Some important points to keep in mind

Planning must limit membership to the following groups: 

  1. People living in certain organizations (such as nursing homes) or need of home care, or
  2. People who are eligible for Medicare and Medicaid, or
  3. People with disabilities (diabetes, end-stage kidney disease) (ESRD), AIDS, Chronic Heart Failure, or Dementia). Programs can continue to limit membership. You can join the SNP at any time.
    • Programs should guide the services and providers needed to help you stay healthy and follow the instructions of your doctor or other health care provider.

If you have Medicare and Medicaid, ensure approval of your health care plan by all the doctors and your healthcare providers

 

Hopefully, this article was helpful for you to get the required information about Medicare Ohio. You must make your decision very smartly to get maximum benefits at the lowest cost possible. Choose the plan according to your requirements. The best plan is one that covers the maximum of your health care requirements and is also within budget. 

Top-Health-Benefits-That-Employers-Can-Offer-Health-Insurance-Claimlinx

How to See if Your Healthcare Plan Covers Your Prescriptions

There are many reasons why you’d want to look out if your insurance plan covers your medication prescription. If you’re looking around for a new insurance plan and it’s important to find out if your current medications are covered.

Maybe your healthcare professional just prescribed an alternative medication and you would like to see it before you choose the insurance policy. While this information is searchable, it does require some skill to find it. We will help you through this article.

Whenever doctors prescribe an expensive form of medication, the first thought in your mind is if your insurance plan covers the cost. Or even you would like to understand what tier a drug is in, or whether it is a preferred or non-preferred brand.

You have different options for getting this information. We’ll assist you in understanding where to look for it.

 

Does my new insurance plan cover my prescription?

Follow the following steps to figure out the prescriptions covered under your new Marketplace plan:

  1. Visit your insurer’s website to review an inventory of prescriptions your plan covers
  2. See your Summary of advantages and Coverage, which you’ll get directly from your insurance firm, or by employing a link that appears within the detailed description of your plan in your Marketplace account.
  3. Call your insurer to inquire what’s covered. Have your plan information available. It all available on your insurance card, the insurer’s website, or the detailed plan description in your Marketplace account.
  4. Check out any details your insurance firm sent you for the coverage you have got

 

Summary of Benefits and Coverage (SBC):

This document may be a summary of what the health plan covers. While the formulary doesn’t actually tell you ways much different tiered drugs will cost you, the SBC will outline what quantity your copay is for every tier.

When you’re buying healthcare plans or determining whether to stick or to not stick with your current one, use the formulary and SBC to search out whether a selected medication is covered. Based on an example of a tier 3 medication such as insulin SBC, is to be considered a “non-preferred brand”, meaning that you simply need to pay 40% of the drug’s cost. When choosing a health plan option, it’s important to get one with a cheap premium provider (the amount you buy insurance every month) and also consider which plan has the simplest coverage and possibly the lowest out-of-pocket expenses for your medical needs.

During open enrollment periods (the time people are buying new plans, insurance companies are required to form list of medicines and SBCs available. It’s your right to request a list of medicines for an idea you’re buying.

 

Can I attend my regular pharmacy to urge my medication?

Just like different health plans cover different medications, different health plans allow you to buy your medications from different pharmacies (called “in-network pharmacies”). Call your insurance firm or visit their website to seek out whether your regular pharmacy is in-network under your new plan and, if not, what pharmacies in your area are in-network. You’ll also learn if you’ll get your prescription delivered within the mail.

If you’ve got additional questions, call 800.858.1772 to get the required information.

 

ClaimLinx helps auto dealer save money

It doesn’t matter what type of business it is. ClaimLinx can help owners and their employees save on health insurance.

The New Hampshire Auto Dealers Association found out just that when some of its members started working with ClaimLinx. On average, businesses that use ClaimLinx’s Solution save between 20 to 40 percent on their health plan within the first year.

ClaimLinx focuses on savings

Tom Quigley, Co-Owner of Claimlinx, said all it takes for business owners to start saving is a willingness to look at their health insurance differently. His company’s Solution combines traditional group insurance with a self-funded plan. That way employers can save money while providing great benefits.

“We have developed a solution on health insurance,” he said. “The main focus of our business is showing business owners how to use tax laws to greatly reduce the cost of health insurance for both the employer and the employees.”

A real example of savings for a small business

AutoServ Dealerships in Tilton, NH are members of the New Hampshire Auto Dealers Association who became clients of ClaimLinx two years ago. In the first year, they saved almost $100,000 on their health insurance. What’s more is they were able to pass that savings onto their employees as well. Their workers saved about 5 percent year over year while keeping deductibles lower than with the group’s previous plan.

Donna Gaudet Hosmer, General Counsel at AutoServ, said they turned to ClaimLinx because they needed a better option for health insurance at their company.

“The reason we chose ClaimLinx was primarily cost,” she said. “We needed an affordable option that reached a diverse array of employee needs in terms of benefits and affordability.”

How to start saving on health insurance

ClaimLinx works with businesses of all sizes. Qualified consultants are always available to start a consultation. They start by identifying each clients needs and balancing them with the costs of the health plan.

By taking the health plan out of the hands of traditional insurance companies, there is an amazing opportunity for savings while still providing great benefits. That means low deductibles and copays at a low cost to the employer.

Tom Quigley said for most companies this all comes down to setting up a plan that balances risk with savings.

“Really what the ClaimLinx solution boils down to is a math problem,” he said. “It’s really is as simple as putting a couple of keystrokes on your calculator. And to literally figure out the risk and the savings. What most people find is that the savings generated is greater than the actual risk associated. Meaning that every single person could go into the hospital or hit their deductible and the company still saves. That’s happening about 90-95 percent of the time.”

ClaimLinx focuses on education

This new way of buying health insurance isn’t just about the plan, though. It’s about educating employees on the best way to use the plan to get affordable healthcare. ClaimLinx turns its members into educated consumers so they no longer feel lost while navigating the health insurance industry.

Donna Gaudet Hosmer said the Solution was “definitely a departure from traditional insurance” but the people at ClaimLinx were there to help with educating members and providers on the new system. She said these resources were invaluable to members at the company. They were able to save money and still get the most out of the plan.

“The cost benefit far outweighs the learning curve to understand how to use it properly and maximize it,” she said. “So it’s been a huge win for us and I would highly recommend other dealers take a look at this.”

Contact ClaimLinx today to schedule a consultation.

Find the Best Health Insurance

How to Find the Best Health Insurance

Shopping for a plan that is the perfect health insurance plan for you and your family is surely a challenging task. Meeting all the requirements and minimizing the cons can take a lot of research. However, there are some factors that help in narrowing your search and save plenty of your time and effort. Take a look at the following factors. We hope they may prove to be helpful.

 

Choose Your Health Plan Market Place

Many people are provided a health insurance plan through the company they work for. In case you are included in those people then you might not need to search for a government insurances plan or insurance marketplaces. The company you work for is your marketplace.

In case your company offers you a insurance plan, but you want to do a research about what other alternates are present then you are free to do that but it is a fact that they might be a lot more expensive. This is why the company tends to pay portion of the insurance premiums for their employees because on average the total premiums are lower.

You can buy an insurance plan from public marketplace on your state, if it is available. You may also search federal marketplace to find insurances with lowest premiums. The first step to find a health insurance is that you go to Healthcare.gov and enter your zip code while open enrollment is in process. You will be directed to the exchange in case it is present otherwise federal marketplace will be available for you. To buy the insurance plan you can either contact a private firm or can get it directly from insurer.

 

Compare the Types of Insurance Plans

You might see a set complicated alphabetical combinations that might confuse you while choosing for the right insurance plan. Common health plans include, POS, PPOs, HMOs and EPOs. Your choice of insurance plan will determine the benefits you will able to enjoy and what expenses you would have to pay out of your pocket.

Keep in mind to check the basic set of features of an insurance policy before buying it. There is a summary of benefits present with plan and the price is also mentioned with the title in an online marketplace. The hospitals and doctors covered by the particular health plan are also mentioned and the decision must be made accordingly. A benefits administrator in your workplace can provide you details of different insurance plans.

 

Choosing a Plan Based on Hospital Ward

You should never compromise on your health standards. So, you should see that the insurance plan you are choosing provides you A-plus service. If you don’t like to stay between lots of patients, you may choose 1 bedroom or double-A bedroom. If privacy is not an issue for you, you can use 4 bedroom B1 rooms or 8-9 C bedrooms. The more the privacy of the bedroom, the more is the cost and the more are the health insurance premiums satisfactory. Therefore, a good wardroom will provide you comfort but not everyone is able to afford such premium plans.

Upgrading from an A to B ward will cost several hundred dollars and may increase with the increase in your age. You need to make sure you get treated according to the plan you choose and it is up to your standards and the money you pay.

 

Choosing a Plan Based on Benefits and Medical Coverage

After choosing the type of wardroom, you must also compare the benefits and prices of the plans. In this way, you can estimate if your medical expenses will be covered in the money you pay and it will certainly help you in emergencies. The plans offer variations in annual payment, additional benefits, and post as well as pre-hospitalization expenses. The base coverage for all IPs is the same but they differ in packages.

For choosing plans based on benefits, look for annual limits first hand because these benefits provided depend upon their annual limit consumed in a year. Such as the annual limit for A wardroom is far more than the B wardroom and so are the benefits. Also, you should consider if you are covered in case of emergency by pre and post-hospitalization coverage. Psychiatric patients must choose plans with post-hospitalization services. Some IPs also give critical illness coverage so that you are covered if you suddenly suffer a stroke or a heart attack.

The stipulations a plan offers is also an important factor in choosing an IP. These riders provide a variety of benefits in long term. These stipulations include immediate family hospital accommodation, emergency outpatient coverage, coverage for post-hospitalization alternative treatment. They also usually cover 50% of the co-insurance and may even cover the annual deductible.

 

Choosing an IP Plan Based on Cost

The cost of IP plans is the most important factor because not enough money cannot provide you quality service and you may need to pay more or withdraw from the plan. If you are not diseased and don’t require a particular health plan, go for a low-cost plan. The cost increases with age and the standard of the wardroom. For example, if some plan costs 200 dollars for a 20-year-old, the same plan will cost 500 dollars for a 65-year-old. You can estimate if your plan is reasonable, you need to find out the plan’s total coverage per dollar of premium.

You need to make sure that you can afford the increment cost with the age of the plan you choose. If you have 200 dollars annually in your 20s, you should expect it to be $700 by the age of 40. . However, if you have A ward rooms, you need to pay from your pocket at an older age because it costs too much.

Considering all the above factors, you will get yourself a best health insurance at the end of the day. Compare best and worst health insurance companies and find the right one for you.

 

 

2021-Employee-benefits-planning

How and Why to Start Planning Your 2021 Employee Benefits

Have you ever wondered what keeps you motivated even after working for hours? Did you ever give a thought to how employee benefits bring about a difference outside your work life? If you did not, I believe it’s high time that you do because it notably has a significant impact on you, your family as well as your lifestyle!

Employees of all ages seek security and that too originating from your employer is a plus. In the modern fast-paced world of today, where competitiveness is at its peak, a driving factor to attract and retain individuals like you is by offering Employee Benefits. It portrays the organizations are not only investing in the short-term but the organization, as an employer are looking out and concerned for your future that lies ahead of you as well.

Now let us have a deeper understanding of the much familiar term ‘Employee Benefits’

 

What Are Employee Benefits?

Employee Benefits, also commonly known as fringe benefits are non-financial compensation that is provided to you as part of an employment contract other than your salary. It may be required by law, depending upon the country you currently reside in, or could be also due to a risk that is associated with your job. The purpose of employee benefits is to increase your economic security as an employee.

Below is a check-list of the employee benefits commonly being provided by organizations:

  •       Health Insurance
  •       Disability Insurance
  •       Casual Leaves
  •       Sick Leaves
  •       Vacation Leaves
  •       Retirement Plans
  •       Well-being Program
  •       Tuition Reimbursement
  •       Gym Reimbursement
  •       Loan Contribution
  •       Transportation Facility
  •       Employee discounts
  •       Free lunch

 

Why Are Employee Benefits Important For You

Employee Benefits acts as security. This is where above 70% of the population is willing to settle for their security and wellbeing, even in comparison to high salaries being offered.

Here are some reasons why employee benefits are important to you:

  •       They ensure your security
  •       They ensure to facilitate you will all resources at their disposal
  •       They have a strong impact on your motivation towards your work
  •       They contribute towards increased satisfaction while being at work

Note: If an organization is offering a good salary along with additional benefits, it is the right moment for you to grasp the opportunity before it’s too late!

 

Why Is 2021 Benefits Planning Important?

We are all aware of the global pandemic and the unfortunate events that it brings along. As it continues to wage on, the COVID-19 pandemic has been a wake-up call for all employees to get themselves secured. This is observed as a reflection in the employees being super concerned about the additional benefits and support provided by their employer to help create ease in such tough times.

On this account, all employees need to start focusing on their concerning employee benefits to get themselves secured for any unfortunate causality that could occur as a result.

Here are some common reasons to why you should step ahead into employee benefits planning for the year 2021:

 

Healthcare Coverage

You have probably heard the common phrase ‘Health is Wealth’. Yes, your health is the most important factor and should be your top priority, especially in such times. You need to consider the maximum amount of opportunities from where you could get medical coverage as part of employee benefits.

 

Telehealth facility:

It is an additional sub-category that is on the rise nowadays. Telehealth is where you could get connected to a doctor through a telephonic call or video chat. As the graph for COVID-19 increases, there has been observed an increasing trend toward telehealth services, with over 60% population being dependent on it.

Therefore, it is extremely important to consider the benefits of health coverage in employee benefits planning for the year 2021.

 

Mental Health

A survey in 2020 investigated the after-effects of COVID-19 on employees where there was a significant increase in individuals linking the global pandemic as one of the most stressful times of their lives. This is where employees were not sure about job security where each one of us felt threatened that our organization might be laying us off.

It is hence important, to consider your mental health before even giving a second thought to any of the factors. For this reason, you should start looking into organizations and programs that cater to these in addition to the usual benefits being provided.

 

How To Start Planning Your 2021 Employee Benefits

Planning employee benefits has become essential in the world of today. Having the right employee benefits will give you a distinct advantage in addition to other facilities provided by either your organization or the law of your state itself.

Take into consideration the following steps while planning on your 2021 employee benefits:

 

Prioritize what’s benefits are important to you

As an employee, it is important to evaluate what matters to you. You should be the one deciding what is important, what is relevant, and what is it that will facilitate you in the longer-run as well. Until and unless, you do not have a goal or determination inside of you, it will be far impossible to benefit both, you and your dependents as a result.

 

Differentiate between required benefits and optional benefits

While organizations are increasingly providing employee benefits, it is important to focus on what is best suitable for you. You, as an employee, should be decisive and have the ability as well as a skillset to differentiate between what is necessary and what is not.

Often some startups offer small business benefits since they are not enough financially stable to offer you a range of benefits. For instance, small business benefits could include flextime, telecommuting, paid time off, or even well-being programs. For some, the above would be required benefits where in comparison some employees might have it on their optional benefits list.

Hence, now once provided with both options, you are free to select the one that fulfills your needs and requirements.

 

Dig Deeper into your budget constraints

Having a focused and realistic idea of your budget will aid in understanding and utilization of the benefits important to you and your family. It will provide you with a holistic overview of the employee benefits to plan on while also knowing the ones you can compromise on.

In summation, 2021 is almost here with a roaring start, that links back to employees making decisions about their benefits program and the option available. Where continued unemployment is at its peak, employees should wholeheartedly dedicate a great deal of time settling themselves for a brighter future!

Contact Claimlinx today to schedule a benefits consultation.