09-27-2023 Primtime Living - Flipbook - Page 26
26 A Special Advertising Section of Baltimore Sun Media Group | Wednesday, September 27, 2023
Understanding insurance,
continued from page 24.
Point of Service (POS): A type of plan
where you pay less if you use doctors,
hospitals, and other health care providers
that belong to the plan’s network. POS
plans require you to get a referral from
your primary care doctor in order to see
a specialist.
Preferred Provider Organization
(PPO): A type of health plan where you
pay less if you use providers in the plan’s
network. You can use doctors, hospitals,
and providers outside of the network
without a referral for an additional cost.
Health Savings Account Eligible
(HSA-Eligible): There are a lot of rules
connected with an HSA plan. They are
similar to a High-Deductible plan, with low
premiums, but before the plan covers services, you must pay your deductible. You
cannot use funds from the HSA account
to pay your premiums, but “money that
you deposit into your HSA can be deducted on your taxes. Also, when you open
an HSA, it can stay with you for life, even
if you later receive coverage through
an employer or are covered with a nonHSA eligible plan,” according to Maryland
Health Connection.
Catastrophic Health Insurance:
Catastrophic health insurance plans have
very low monthly premiums and very high
deductibles. They may be an affordable
way to protect yourself from worst-case
scenarios, like getting seriously sick or
injured. But you pay most routine medical expenses yourself. Only those under
30 years of age may apply for them.
For those over 30, they can apply for an
exemption.
Next, these are general terms it’s
important to know so when you compare
plans, you see exactly how they differ. It
comes down to what you pay versus what
you get.
Monthly premium: The amount you
pay to your insurance company each
month to have health insurance.
Deductible: How much you have to
spend for covered health services before
your insurance company pays anything
(except free preventive services).
Cost-Sharing: also known as
Copayments and coinsurance: Payments
MD health connection,
continued from page 22
you make to your health care provider
each time you get care. Copayments are
in dollars; coinsurance is a percentage of
the charges. Examples are $20 for a doctor visit or 30% of hospital charges.
Out-of-pocket maximum: The most
you have to spend for covered services in
a year. After you reach this amount, your
insurance plan pays 100% for covered
services.
Plan Differences
All plans in the Maryland Health
Connection must, by law, offer the following benefits. They include certain preventive health services, routine health care
that includes screenings, checkups, and
patient counseling to prevent illnesses,
disease, or other health problems.
Some plans include telehealth coverage or other additional services, but
it varies for the different carriers. You
can see their rules or availability when
you compare plans. Additional information is available on the Maryland Health
Connection website.
Here are the required medical services
included in all plans.
• Ambulatory patient services (outpatient care you get without being
admitted to a hospital)
• Emergency services
• Hospitalization (like surgery and
overnight stays)
• Pregnancy, maternity, and newborn
care (both before and after birth)
• Mental health and substance use
disorder services, including behavioral health treatment (this includes
counseling and psychotherapy)
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices
to help people with injuries, disabilities, or chronic conditions gain or
recover mental and physical skills)
• Laboratory services
• Preventive and wellness services
and chronic disease management
• Pediatric services, including oral
and vision care (but adult dental
and vision coverage aren’t essential
health benefits)
• Birth control coverage
• Breastfeeding coverage
your application.
If you need help in other languages,
interpreter services are available for free.
On the home page, in the upper righthand corner, is a drop-down menu listing what looks like dozens of languages.
English and Spanish have their own buttons. What’s most important is everyone
can access the information in their own
language.
Help is Available
Are you feeling a little confused?
Understanding health care insurance
options is far from simple. An attorney I
know who manages a company was in
charge of purchasing a health care plan for
the employees. He got confused trying to
figure out all the options. So, if it’s difficult
for the rest of us, it’s not surprising.
However, there are excellent solutions:
Maryland Health Connection, like all programs under the ACA, has Navigators.
They deliver in-person outreach, education and enrollment in health plans and
public insurance options. Consumers can
get one-on-one assistance from our statewide network of navigators.”
Navigators can help you determine
your eligibility, help you enroll or hand you
off to an insurance broker who can differentiate between the different plans and the
companies that offer them. To find a navigator in your area, visit the Find Help page
and scroll down to “In-person assistance.”
There you will find a link for a PDF that lists
local navigators throughout the state.
In addition to Navigators, Maryland
Health Connection works with brokers
who can explain all the differences in plans
and in coverage and will aid you in selecting the best product for your personal situation. At the top of every page on the website, there is a tab that says, “Find Help.” A
few of the options on that page are:
• Need help in 30 minutes or less? You
will fill in a form, and a broker will call
within 30 minutes.
• You can get help with Medicaid or
private health plans by calling the
Call Center: 1-855-642-8572. Deaf
and hard of hearing may use the relay
service.
• Live chat.
• Download a free mobile app.
• Call center hours: Monday to Friday
8 a.m.-6 p.m.; Saturday 8 a.m.-2
p.m. These are extended during open
enrollment.
• There are even enrollment events:
Visit www.marylandhealthconnection.gov/find-help.
Michele Eberle is the executive director
of Maryland Health Benefit Exchange, the
public corporation and independent unit
of the Maryland state government established in 2011 to launch our insurance
marketplace, Maryland Health Connection.
Eberle says, “We want to help everyone have health coverage. We want to
work with you. That’s our goal, to make
sure every Marylander has health insurance. It’s part of our mission. And each
year, we insure more Marylanders, more
young adults, more people of color. Now,
with the Inflation Reduction Act, everyone who enrolls via on Maryland Health
Connection will have access to additional
savings.”
It seems that each year, the Maryland
Health Connection offers more options,
more ways to save money, more choices
when it comes to having health insurance.
In March 2010, when the Affordable Care
Act passed, well over 40 million Americans
did not have health insurance. In a press
release from May 2023, the Centers for
Disease Control and Prevention (CDC) stated that “among working-age Americans
(ages 18-64), 12.2 percent did not have
health insurance in 2022, a decrease from
14.7 percent in 2019.” The good news is
that this is improving every year.
If you don’t have insurance, reach out
today to the Maryland Health Connection.
They want to do their best to insure you
during this year’s Open Enrollment.