Health Insurance Archives - Page 3 of 52

What Is a Point of Service (POS) Health Plan?

what is a point of service health plan text overlaying image of healthcare blocks Everyone needs health insurance to cover them in case of an emergency or unexpected illnesses. It’s also best to have health insurance for things like checkups and medications that keep you from getting sick in the first place. Unfortunately, there are so many choices in health plans that it can be hard to figure out which type is best for you. To make sure you’re covered when you need it, it’s important to choose a plan that not only fits your needs but also your wallet. A Point-of-Service (POS) plan is one of the many things you can do. Even though these plans aren’t as common as HMOs and PPOs, it’s still a good idea to look into them.

What Is A Point-of-Service Plan?

A point-of-service (POS) plan is a type of managed-care health insurance plan that gives different benefits based on whether the policyholder uses in-network or out-of-network healthcare providers. You can choose whether or not to stay in the network each time you need health care services. With this type of insurance, all of your costs rely on the “point” of service, which is the doctor or hospital where you get care. A Point of Service (POS) plan has some of the same benefits as HMO and PPO plans, but the amount of benefits depends on whether you get your care from a provider in the health insurance company’s network or from a provider outside of the network.

How Point-Of-Service Plans Work

A POS plan begins like an HMO plan, you have to choose a primary care provider (PCP). Your PCP is in charge of coordinating your health as well as giving you referrals to see specialists, which will not be covered without a referral. A POS is also similar to a PPO in that it still covers some services that you get out-of-network, but you will have to pay more than you would for in-network care. The POS plan will pay more for a service outside of the network if the primary care doctor sends the policyholder there instead of the policyholder going outside the network without a recommendation.

The premiums for a POS plan are between those of an HMO, which are cheaper, and a PPO, which are higher. Co-payments are usually only $10 to $25 per visit when you go to a doctor who is in your plan’s network. POS plans also don’t have fees for services that are covered by the plan. This is a big difference from PPOs. POS plans cover the whole country, which is good for patients who move a lot. Out-of-network costs tend to be high for POS plans, which is a bad thing. When a deductible is high, it means that patients who use services outside of their plan’s network will have to pay the full cost of their care until they hit the deductible. If a patient never uses out-of-network services on a POS plan, they might be better off with an HMO because the premiums are cheaper.

Point-of-Service Cost

On the Affordable Care Act (ACA) marketplace, a POS plan costs an average of $505 per month for a 30-year-old, $568 per month for a 40-year-old, and $794 per month for a 50-year-old. On the ACA marketplace, the price of a POS health insurance plan relies on a number of things. Some of the things that affect how much you pay for health insurance are:

Age
Where you live
Tobacco use
Plan tier
Dependents
Plan design
Insurance Company

Additionally, the costs of your plan rely on where you get coverage. For instance, the cost of individual health insurance plans bought directly from an insurance company is different from the cost of plans bought through the ACA marketplace. If your workplace offers a POS plan, you can expect to pay much less because the premiums for employer-sponsored plans are subsidized.

Advantages and Disadvantages of Point-of-Service Plans

POS plans often cost less than other types of health insurance, but they only cover a smaller number of doctors. You can see doctors who are not in their network, which is a good thing, but it will cost you more. Each type of insurance plan has pros and cons. Knowing the pros and cons of POS insurance plans can help you decide if it’s the right choice for you and your family.

Advantages

Affordability – Since POS plans are a mix of PPOs and HMOs, their premiums aren’t always the cheapest. However they are still affordable. In fact they actually cost less than PPOs. Affordability comes into play with in-network copays. POS plans don’t make you pay your deductible before getting coverage. Instead, you pay a copay every time you see an in-network provider. This is beneficial if you’re working within a budget.
Out-of-Pocket Limits – With a POS plan, you have to meet your deductible before any out-of-network care will be covered, but the deductible is lower than a PPO plan, and there are limits. The out-of-pocket limit is set so that you will never spend more than a certain amount for healthcare in a year. Once you meet that limit, your insurance will pay for all of your doctor visits and treatment, both in and out of the network.
Flexibility – With a POS insurance plan, you have to pay your deductible before you can get coverage from a provider who is not in your network. However, the yearly cost is less than PPO deductibles, and you can’t pay more than a certain amount during the year. Once the out-of-pocket limit is met, your insurance will pay for all of your doctor visits and treatments.

Disadvantages

Costs – Even though POS plans are cheaper than PPO plans, which is a benefit, they can still be as expensive as HMO rates. If you don’t fully understand your plan, you may be paying more than you would for another type of health insurance. For example, if your PCP is not in the network, you’ll pay more to see them than if they were in the network of your HMO.
Confusing – Since POS insurance plans are less popular than HMOs and PPOs, they can be hard to understand, making it hard to know how much you’ll pay when you see a doctor or specialist.
Paperwork – These plans also require a lot of paperwork if you want to see a doctor who isn’t in their network and pay their fees up front, which may not be possible with your budget. After seeing the doctor, you’ll need to file a claim for repayment and wait for a decision, which can be scary.

POS Vs. HMO

Most of the time, HMO plans cost less than other plans. The premiums and out-of-pocket costs for HMO health insurance are much cheaper than those for POS plans. Even though HMO health insurance is less expensive than POS health insurance, it has fewer benefits. Unless it’s an emergency, HMO plans don’t cover care from doctors who aren’t in their network. If you go to a source who is not in your network, you have to pay for the whole service. HMO plans require you to work with a primary care provider and get a referral to see an expert, just like POS plans. Because care from outside the network isn’t covered, HMO members have access to a much smaller network of general care providers, specialists, and hospitals.

POS Vs. PPO

One of the most popular types of health insurance is PPO. You don’t need a referral to see an expert if you have PPO health insurance, and you can see a doctor in or out of your network. PPO health insurance is often a good choice if you don’t mind taking care of yourself. In the ACA marketplace, the average monthly rates for PPO and POS plans are about the same.

POS Vs. EPO

An Exclusive Provider Organization (EPO) plan is similar to an HMO plan. An EPO plan pays for medical services when you go to a source in the plan’s network. If you go to a doctor who is not in your network, you will have to pay the whole price (except in an emergency). However, if you have EPO insurance, you usually don’t need a primary care provider or a referral to see an expert. If an expert is part of the EPO’s network, your insurance company should pay for the service. POS plans tend to be more expensive than EPO plans in terms of cost. In general, health insurance plans that cover care outside of the plan’s network cost more than plans that only cover care within the network.

Working With EZ

There are a lot of different kinds of health insurance plans to choose from. So, it all comes down to what you want, how much money you have, and how healthy you are. The best way to find the right plan for you is to look into what each plan has to offer. So, you can get the most service for as little money as possible. Remember that health insurance is important, even if you’re in good health most of the time. You never know what could happen, so it’s best to be safe. To get started, just type your zip code into the box below. Or call 877-670-3557 to talk to one of our certified agents.

Telehealth Is On The Rise

Telehealth Is On The Rise text overlaying image of a phone Most of the time, doctors and other health care workers see their patients in person at a place like a doctor’s office, clinic, or hospital. However, doctors and nurses can now diagnose, treat, and keep an eye on their patients’ care online. Thanks to computers, smartphones, and other new digital technologies. Using technology, telehealth is a way of providing health care services from a distance. It can be anything from doing medical visits over the computer to keeping an eye on a patient’s vital signs from afar.

The best part is telemedicine isn’t an expensive luxury like some people believe. In fact, according to a study done by The American Medical Association 33.1% of adults living under 100% of the federal poverty level ($14,580 per year) have used telehealth in the last year. So why is telehealth so popular and how does it benefit you? We’re glad you asked. Telehealth has a lot of treatment uses and benefits that virtually anyone can enjoy.

Telehealth Treatment

It may seem like a virtual treatment couldn’t be as thorough as an in-person appointment. While to an extent that’s true. Unless you need something like a shot or emergency care, a virtual appointment can do everything an in-person one can. All of the following things and services are possible with telehealth:

Recording vitals – You can send your weight, food intake, blood pressure, heart rate, and blood sugar levels to your doctor either manually with at home equipment or a wearable monitor.
Check test results – Telehealth isn’t just about appointments. You can also check your test results and prescription refills using the online portal. The online portal can also let you message your doctor directly or even schedule an appointment.
Coordinating care – You can share information like your test results, diagnoses, medications and exam notes between your PCP and any specialists you see. Right from the comfort of your own home.
Reminders – Telehealth includes being able to receive emails or texts as reminders for appointments, tests, or procedures.

Advantages Of Telehealth

Using technology to provide health care has many benefits. Such as saving money, being more convenient, and being able to help people who have trouble getting around or who live in distant areas without a nearby doctor or clinic. Because of these things, the use of telemedicine has grown significantly in the last ten years. Now, 76 percent of hospitals in the U.S. use telehealth to connect doctors and patients directly. Ten years ago, only 35 percent of hospitals did this.

During the COVID-19 virus outbreak, telehealth became even more important. People are more interested in and use technology to give and receive health care because they are afraid of sharing and getting the virus during in-person doctor visits. Other benefits include:

Improved access to providers

Most doctors who work in rural areas are family doctors or general practitioners. This means that they might not have access to or knowledge of more specialized kinds of medicine that rural patients need. Telehealth can help in this situation. Telemedicine software lets healthcare groups give patients in rural areas care that is more specialized. Or more up-to-date than they might otherwise be able to get. Patients are more likely to go to the doctor, now that it is easier for them since they can see providers without leaving their homes.

Flexibility

The main way that telehealth makes things better for patients is by making things easier for them. We all know that going to the doctor can be a pain. Taking time off work to drive 20–30 minutes to the doctor’s office, then sitting in the waiting room for another 20–30 minutes, having a short visit, and then driving home again is a lot of time. This makes people less likely to come in to see their healthcare provider. Telehealth cuts out almost all of that time and reduces it to a scheduled meeting that can be taken anywhere with a smartphone. It’s so much easier for patients, especially for appointments or checkups that don’t involve a physical test.

Improved patient health

Patients are much more likely to make arrangements for regular checkups and preventive care because telehealth makes it easy for them to do so. You might not think it’s worth the trouble to make an in-person meeting for something you think is small, but you could make a telehealth appointment instead. This means that you are living a healthier life generally and keeping an eye on how your health is going. Telehealth also has a lot of benefits for people who have long-term illnesses and have to follow a strict care plan. Routine checkups are much easier to do without having to go to the doctor’s office.

Remote patient monitoring and other more advanced types of virtual care can help you with chronic conditions even more by keeping track of important health data in real time so that problems can be caught as soon as they happen. Remote patient monitoring tools, such as blood pressure cuffs, smart blood glucose monitors, and heart rate monitors, can help telehealth and telemedicine appointments be more effective and improve your general health.

Disadvantages

Telehealth makes it easy and cheap to see your doctor without leaving your house, but it does have a few drawbacks. Not every kind of visit can be done from afar. You still have to go to the office for things like imaging tests, blood work, and treatments that need a more hands-on approach. Cost is another slight downside. During the COVID-19 outbreak, insurance companies are paying for more and more telehealth visits. However, some services may not be fully covered, so you may have to pay for them yourself. Additionally, telehealth requires telecommunications equipment to function properly. However, in order to gain the benefits of telehealth, many patients must have access to laptops, mobile phones, and tablets.

People in remote locations suffer with limited internet bandwidth and unpredictable connectivity. To function efficiently and without latency, video conferencing requires high internet rates. Accessing telehealth services may be challenging if you do not have a constant, stable connection.

Is Telehealth Covered By Insurance?

Telehealth services are starting to be covered by some private insurance companies, but telehealth coverage is very different from one state to the next. This is because each state has its own way of defining telehealth and paying for it. Since insurance plans vary, it’s important to check with your insurance company or the billing department of your health care provider for the most up-to-date information on how telehealth services are covered.

Preparing For A Telehealth Appointment

If you are fortunate enough to have access to the necessary equipment and internet, preparing for a telehealth appointment is fairly easy. Although, some people may find it hard to switch from in-person to online meetings, especially if they aren’t used to the technology. By taking a few steps before your appointment to prepare, you can make sure your visit goes smoothly.

1.Add it to your calendar.

Add your meeting to your calendar so you don’t forget once it’s set.

2.Use the best camera.

This can be connected to your phone, laptop, tablet, or desktop computer. If you can give your doctor a clear picture of what’s going on, he or she will be better able to understand what’s going on and help you.

3.Test your camera and microphone.

Practice with a family member or friend before your online visit with your doctor to make sure you know how to use your camera and microphone. Most devices have microphones and speakers built in, but you may need to turn them on or allow the telehealth app or website to use them. Using headphones or earbuds may make it easier for you to hear your doctor and for your doctor to hear you, but you should try them out first to see what works best.

4.Check your internet connection.

If you aren’t using Wi-Fi, try using a wired connection to your router with an ethernet cable to get the best signal. If you are using Wi-Fi, you can improve your link by being close to the internet router and having as few devices as possible connected to it.

5.Charge the device.

If you’re using a phone, laptop, or tablet that doesn’t have a cord, make sure the battery is charged enough to get you through your meeting. Try to charge it the night before your meeting.

6.Find a good spot.

Try to keep your area as clear as possible. Try to go somewhere with good lighting so that your doctor can see you well. Put your device on a stable surface so you can move around if you need to. Try moving your device so that the camera can see your head and shoulders.

7.Write down questions

If you are ready for your visit, you and your doctor will be able to talk about everything you need to. So, write out your questions or concerns and any symptoms you want to remember to bring up.

Working With EZ

This is just the beginning of how healthcare will change in the future, and many companies want to be a part of telemedicine so that more people will go to the doctor and hopefully catch a problem before it gets worse. The first thing you need to do is find the right health insurance that covers telehealth. No one likes to spend hours reading about different plan perks and costs. So, why not let a professional do all the hard work for free? There is a way to get cheap health insurance without having to go through a lot of trouble. A qualified EZ insurance agent can explain what each plan’s pros and cons are, and help you come up with the plan that works best for you.

Not to mention that EZ agents can save you hundreds of dollars a year on your health insurance bills. We do this by being able to look for the cheapest rates both on and off the market. We can also find and use any savings you might be able to get. Your agent won’t just help you find a plan, though. We also help you keep it up to date. We can help you make claims with your insurance company and help you renew your policy when it’s time. To get started, just type your zip code into the box below or call 877-670-3557 to talk to one of our certified agents.

Mental Illness and Health Insurance

mental illness and health insurance text overlaying image of flowers falling out of a cutout of a head In the last few years mental illness has steadily become a topic of conversation for many people. We’re seeing people take their mental health more seriously. It’s important to take care of your mental health. In fact, it’s just as important as your physical health. Insurers haven’t always seen it this way, though. In the past, many health insurance companies covered physical health problems greater than mental health problems. However, thanks to the Mental Health Parity Act and the Affordable Care Act, health insurance covers mental health the same way it covers physical health. Below we’ll look at both of these laws and why mental health is so important.

Mental Health Parity Law

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Act was passed in 2008. The law is more commonly known as the mental health parity law or the federal parity law. It says that insurance companies must treat coverage for mental illness and behavioral health and substance use disorders the same as coverage for medical and surgical care. This includes treating them the same financially. For example, an insurance company can’t charge a $40 copay for an office visit to a mental health professional when they only charge a $20 copay for most medical office visits.

The parity law also covers limits on treatment that are not related to money. For example, it used to be common to put limits on the number of visits to mental health care that could be made in a year. The law has pretty much done away with these annual limits, but it doesn’t stop the insurance company from putting limits in place that have to do with “medical necessity.”

Health Plans Affected By The Mental Health Parity Law

In general, the following types of health insurance are covered by the mental health parity law:

Employer group health coverage for companies with more than 50 employees
Plans bought through a health insurance exchange
Children’s Health Insurance Program (CHIP)
Most Medicaid programs, however requirements can vary from one program to another

Some other plans and programs run by the government are still not covered by the parity law. The federal parity law does not apply to Medicare, but it does apply to Medicaid. Some state employee plans, like those that cover teachers and people who work at state universities, can choose not to follow the parity rules.

Diagnoses Covered By The Mental Health Parity Law

The federal parity law covers all mental health and substance-use disorders that a health plan covers. But a health plan can choose to not cover certain diagnoses, whether they are in the physical/medical realm or the behavioral/mental health realm. This is because the parity law doesn’t require insurers to offer mental health benefits. Instead, it says that if mental health benefits are offered, they can’t have stricter requirements than physical health benefits. Your plan’s description of mental health benefits should tell you about any exceptions.

Mental Health And The Affordable Care Act

The Affordable Care Act (ACA) was passed in 2010, and its goal was to make healthcare more affordable. Plans that follow the ACA guidelines include mental health care as one of the “10 essential health benefits”. This means that if you sign up for an ACA-compliant health plan, your mental health services are covered. The ACA also says that insurance companies have to put a limit on how much customers have to pay out of pocket and that there can’t be limits on how much mental health care is covered annually or for a person’s whole life. These steps make sure that people can get mental health insurance and that it is affordable.

What Mental Health Services Are Covered?

All ACA compliant plans should cover mental health as an essential health benefit. Your plan should cover some or most of the cost of mental health services, just like it would for other medical conditions. All plans under the ACA must cover the following mental illness services:

Outpatient individual or group counseling and therapy
Diagnostic services like psychological testing and evaluation
Ongoing outpatient treatment such as treatment programs and medication management
Outpatient treatment for alcohol or chemical addictions
Detox services
Substance abuse recovery treatment
Inpatient mental healthcare in a psychiatric facility

Why Mental Health Coverage Is So Important

There are many reasons why having health insurance that covers mental health needs is a good idea. Mental health issues can happen to almost anyone at any time, with most of these issues needing treatment. The cost of therapy and medication can quickly add up and get expensive. If you don’t have insurance for mental health, you would end up paying out-of-pocket for your care. It could easily amount to tens of thousands of dollars. On top of being financially beneficial, mental health coverage can also save lives. If you have a mental health condition, it’s hard to put a price on how important treatment is. Let’s look further into the impact mental health has.

Physical Health

Studies show a link between mental health and physical health. Mental illness can cause stress and make our immune systems less effective. Because of this, our bodies may not be able to handle illness as well. When your mind is sick, you might develop anxiety or depression, which can make it difficult if not impossible to stay active. Which can lead to letting your physical health deteriorate and struggle to correct it.

Relationships

One of the most interesting reasons why mental health is so important is that it affects your personal relationships. Mental illness can change the way you talk to your friends and family. People with mental illness are often passive-aggressive, hostile, and unable to join social activities. This can cause problems within your emotional support system. Mental illness can make us want to hurt people we care about for no apparent reason. Taking care of our mental health on our own and, if needed, taking medicine can help us live a mentally stable life and keep our relationships.

Emotional Well-Being

How you feel on the inside every day is just as important as how healthy your body is. Advice about mental health shows how a negative mind can make you feel sad, angry, or uneasy. Taking care of your emotional health can help you be more productive and effective at work and in your daily life. You can get advice about your mental health from friends, family, and a psychologist to keep an eye on your emotional and overall health.

Prevent Suicide

A study by the National Alliance on Mental Health (NAMI) found that 46% of people who kill themselves have a known mental health problem. In another study, the US Department of Health and Human Services found that about 60% of people who killed themselves had a mental illness like major depression, bipolar disorder, or dysthymia. This shows the link between mental health and suicide, as well as how early medical intervention and self-care can help reduce the number of suicide deaths. It is important to follow advice to keep our mental health in good shape and to always be aware of the mental health of those around us If you or someone you care about is in trouble, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). This number is toll-free. Anyone can use this service 24 hours a day, 7 days a week.

Prevents Criminal Behaviors

Some studies show that if you have a mental health condition, you are more likely to commit violent crimes. The risk is even higher if you use drugs and alcohol and refuse to get proper treatment. Mental health conditions are often the cause of someone committing crimes against their family or friends.

Financial Stability

One of the many reasons it’s important to take care of your mental health is that it makes you more productive and financially secure. According to research published in the American Journal of Psychiatry, people with serious mental conditions earn 40% less than people without. The World Health Organization also says that depression alone causes nearly 200 million lost workdays every year. It is well known that people with poor mental health are less productive, which hurts their finances. It is important to take care of mental health in the right way if we want good work performance and financial security.

EZ Can Help

Getting help for any signs of mental illness shouldn’t be hard because of how much it costs. We can help if you think you can’t get help because you don’t have enough insurance or can’t afford health insurance. You don’t have to worry about paying for EZ’s help to find an affordable health insurance plan because it is free. We want to make sure that you get the help you need. We’ll give you your own agent, who will compare all the plans available in your area and give you quotes in minutes. We won’t just help you find the best plan, we’ll also sign you up for free. Enter your zip code in the bar below to get free instant quotes, or call 877-670-3557 to talk to a live agent.

Why Annual Physicals Are So Important

Why Annual Physicals Are So Important text overlaying image of a nurse in an exam room Many people do not see the importance in scheduling an annual physical, especially if they’re in good health. However, regular exams are essential to your continued health no matter what age you are. These exams allow your doctors to monitor your health, make necessary adjustments to your medications, and prevent serious health conditions from developing or worsening. Annual exams don’t only help you get healthy but they can also save your life.

What To Expect From Your Annual Physical

An annual physical is a general checkup that looks at your health as a whole. Your PCP will look at your medical history as well as your vital signs such as your heart rate, temperature, and blood pressure. During the visit your doctor will also give you a full physical check. Depending on how old you are and how healthy, your doctor may order more tests. These could include things like cholesterol and blood sugar tests from a lab. It may also include ultrasound tests to check for breast cancer, lung cancer and osteoporosis.

Your doctor will be able to look for common problems that come with aging and make treatment plans if needed. During your physical exam you can also talk to your doctor about lifestyle changes you can make to be healthier. Such as advice on nutrition and exercise. There are several essential reasons to use your yearly physical exam.

Establishing Your Health Baseline

One of the more important things about getting regular physicals is that you and your doctor can learn more about your current health and spot any risks early on. Over time your doctor will check and monitor each of your vitals at each visit. This establishes your health baseline letting your doctor become familiar with what your body’s “normal” is. It helps your doctor know you and your body so they can spot any unhealthy trends early. They will keep an eye out for any significant changes to your health so they can treat it immediately.

Updating Your Vaccines

Vaccines are not just something that kids need. Adults also need to make sure they’re up to date on them as well. Your doctor will keep track of these vaccines at your physical exam and let you know when it’s time to update them:

Covid-19 vaccine and boosters – This vaccine helps people from getting sick or dying from COVID. Everyone age 5 and up should get the vaccine as well as the booster shots as they become available.
TDAP vaccine – The TDAP vaccine protects against tetanus, diphtheria and acellular pertussis (whooping cough). This is a shot you get as a kid but adults need a repeat shot every so often. And pregnant women need this shot every pregnancy.
Flu shot – Flu shots are recommended every year from the time you turn 6 months old.
HPV vaccine – Cancers caused by the human papillomavirus are stopped by the HPV vaccine. In the past few years, the advice that girls and boys ages 11 to 12 get an HPV shot hasn’t changed. But the CDC now says that all women and men up to age 26 should get a catch-up HPV shot. Adults between the ages of 27 and 45 who haven’t gotten the vaccine before might also benefit from a “catch-up” shot.
Pneumonia vaccine – If you have asthma, smoke, or are over 65, your primary care doctor (PCP) may suggest the pneumonia vaccine to keep you from getting a lung illness.
Shingles vaccine – Almost anyone 50 and older is encouraged to get the shingles vaccine every 5 years.
Hepatitis B vaccine – If you have diabetes or another disease that affects your immune system, work in the healthcare field, or live in a group setting like a nursing home, your doctor may suggest that you get the hepatitis B vaccine.

Medication Management.

Any medication that you take every day can sometimes need to be adjusted. This can happen due to your body building an immunity to the medication or your health declining. Your doctor will look over your medications at your annual physical as well as consider any new symptoms you’ve discussed during the visit to decide if they need to increase, stop, or add medications to your treatment plan. They will also monitor to make sure you never take 2 medications that will negatively affect each other.

Updating Medical Records

Your medical records aren’t just paperwork. These records keep an in-depth record of your health history so that it’s easy to compare your current health to the past to help identify health trends. Your Medical records include things like:

History of medication changes
Allergies
Vaccines
Family health history
Past surgeries
Treatment plans
Test results
Weight loss/gain trends
Current health conditions

These records also come in handy if you switch doctors or need to see a specialist, your new doctor will have all the information they need to treat you properly. Medical records are also extremely important in an emergency situation. If you’re unable to speak, your records can help emergency room doctors and surgeons treat you accurately and quickly without accidentally making any health conditions worse. Such as giving you a medicine you are allergic to or that will react badly with current medications. As well as let them know any existing conditions that they might need to be aware of during an emergency surgery.

Building Trust With Your Doctor

Your PCP is your partner in health care. An annual physical check is a great way to get to know your PCP and let your provider get to know you. This one-on-one time with your doctor is a great way to connect and build trust with your doctor. Even if you see your primary care provider for minor illnesses and injuries at other times of the year, these “sick-care” visits are generally about treating specific problems.

During your yearly physical, your health as a whole and the preventive care you need to stay healthy are the main concerns. In addition to learning more about you and how you live, your PCP will give you plenty of time to talk about any worries or questions you may have about medications, treatment plans, or other health problems. The American healthcare system can be complicated, so having a doctor you trust to guide you through it is invaluable.

Saving Money

Some people say that getting a checkup once a year is a waste of money, however getting a checkup once a year at the office of your general care doctor can save you money in the long run. Getting a physical once a year can help keep medical costs down in the future. If your doctor finds a disease or sickness before you feel sick, it will cost less to treat you than if you wait until you feel sick. It’s easier and cheaper to stop a problem from happening than to fix it afterward. Early diagnosis is important for both your health and your bank account. When you make an appointment for your yearly physical, you’re making a cost-effective choice.

How To Get The Most Out Of Your Physical Exam

If you only see your doctor once a year, make the most of it by knowing your family’s medical background and telling your doctor about it. Tell your doctor if someone in your family has been told they have a sickness or cancer. Also, bring a list or a bag with you that has all of the medicines and vitamins you take. This will help your doctor check for possible drug combinations and make sure you are taking the right amount of each drug. Don’t be afraid to talk about changes in your health, even if you think they are small. Some examples would be changes in how you sleep, what you eat, or how you feel. Don’t just worry about your physical health and forget about your mental health.

Getting Health Insurance

Preventative care is a “freebie” built into almost all health plans. Meaning these yearly exams are often free with the right health insurance. A qualified EZ insurance agent can explain what each health plan’s pros and cons are. And help you come up with the plan that works best for you. Working with an agent saves you time and stress because you don’t have to try to figure out legal jargon or read small print. Agents do all the hard work, so you can relax knowing that your coverage will meet your financial and medical needs the best.

Not to mention that EZ agents can save you hundreds of dollars a year on your health insurance bills. We do this by being able to look for the cheapest rates both on and off the market. Our agents can also find and use any savings you might be able to get. We don’t just help you find a plan, though, we also help you keep it up to date. We can help you make claims with your insurance company and help you renew your policy when it’s time. To get started, just type your zip code into the box below or call 877-670-3557 to talk to one of our certified agents.

Why Is Oral Hygiene So Important?

Oral hygiene is actually considered preventative care, just like annual physicals and routine blood work. If you take good care of your teeth and gums, you can stop dental health problems like cavities, gum disease, and even bad breath. Not to mention it helps stop other health issues as well. Oral health is also related to your entire body’s health. For example, if you have an infection in your mouth, the bacteria can actually travel through your bloodstream to other parts of your body. This bacteria can lead to heart disease and strokes. So, taking care of your mouth is an important part of staying healthy in general. Below we’ll look closer at how healthy mouths mean healthy bodies, as well as tips on how to take care of your teeth between dentist visits.

Reduce Risk Of Disease

When we talk about our overall health, we don’t usually think about our teeth and gums. But we really should! Taking care of your mouth can make you less likely to get sick. Research shows that gingivitis or periodontitis (forms of gum disease) can lead to a number of health problems.

Cardiovascular Disease

Healthy gums are one way to lower your risk of heart disease. Periodontal disease is a direct cause of inflammation in your arteries. When the bacteria from your mouth gets into your bloodstream, it causes the arteries to harden. In turn, this increases your risk of heart attack or stroke. Bad oral health is also linked to high blood pressure and dense LDL cholesterol, which raises the risk of heart disease even more.

Alzheimer’s Disease

Bad oral hygiene will inevitably lead to inflamed gums. When oral bacteria travels to the brain, it can actually kill your brain cells! This leads to memory loss. It’s currently estimated that around 40 million people are currently living with Alzheimer’s or dementia worldwide. A pathogenic oral bacteria called spirochetes has been studied as a possible cause of Alzheimer’s disease. This is because significantly more spirochetes bacteria are found in Alzheimer’s patient’s brains than those without Alzheimer’s.

Diabetes

According to the American Diabetes Association (ADA), 37.3 million Americans currently have diabetes, with many more unaware that they even have it. Periodontal diseases can increase the risk of developing or worsening diabetes. This is because periodontal disease makes it difficult for your body to regulate your blood sugar. Just like periodontal disease can cause or worsen diabetes, diabetes can also cause periodontal disease. If you have diabetes it can increase your risk of dental problems that can then offset other health problems. This is because Diabetes increases the risk of infection. In fact 95% of diabetic adults also suffer from periodontal disease.

High-Risk Pregnancy

Researchers have discovered a direct link between gum disease in pregnant women and low birth weight and preterm labors. Premature or low weight infants are susceptible to brain injuries, as well as vision and eyesight problems. Just like with diabetes not only can gum disease cause issues with your pregnancy, your pregnancy can cause issues with your teeth and gums. So it’s important to take close care of your teeth if you’re pregnant or plan to become pregnant. These issues include:

Gingivitis – This is more likely to happen during your second trimester. Symptoms include gum swelling and bleeding, specifically when brushing and flossing your teeth.
Periodontal disease – This is an infection of the structures that support your teeth (gums, ligament, and bones). It happens as a result of untreated gingivitis and can lead to losing your teeth.
Pregnancy Epulis – This is a red, round growth around your gums that can easily begin to bleed.
Tooth Decay – Your pregnancy hormones relax the ring that holds your food inside your stomach. If you suffer from gastric reflux or vomiting from morning sickness, your stomach acids can coat your teeth. Repeated vomiting and reflux can damage your tooth enamel and increase the risk of tooth decay.

Obstructive Sleep Apnea

Teeth grinding is one of the first signs of obstructive sleep apnea. Grinding your teeth can lead to tooth decay and inflamed gums, increasing your risk of infection. Sleep apnea is also directly linked with hypertension, heart disease, and headaches.

Respiratory Issues

When oral bacteria is inhaled into your lungs or absorbed in your bloodstream it can cause some serious respiratory problems. Bacteria can cause respiratory infections, bronchitis, pneumonia, COPD, and lung disease once it’s in your lungs.

Cancer

Cancer is another issue related to oral health. Researchers have discovered that periodontitis can contribute to the development of pancreatic cancer. The bacteria that cause periodontitis can be dangerous, as they damage the tissue surrounding the teeth. Adults with poor oral health were more likely to contract an oral virus that can cause human papillomavirus (HPV), which can also cause cancer. Periodontal disease can also cause lung and blood cancer.

Rheumatoid Arthritis

Rheumatoid arthritis is an inflammatory disease, as we know poor oral hygiene can lead to periodontal disease which causes inflammation in the mouth that eventually spreads to the rest of the body. John Hopkins investigated the link between poor oral health and rheumatoid arthritis. The inflammatory response of joints in Rheumatoid Arthritis patients is comparable to the inflammatory response of a patient’s mouth with Periodontal disease.

Osteoporosis

If periodontal disease gets bad enough, the inflammation and infection can cause a loss of bone tissue. Studies reveal that periodontal disease affects all of the body’s bones, not just the jawbone and teeth. Both osteoporosis and periodontal disease are associated with estrogen deficiency, low mineral bone density, and low vitamin D levels according to the research.

Erectile Dysfunction

Poor oral health can even affect your sex life! Periodontal disease creates infection-prone pockets in your mouth. With the presence of bacteria and infection in your bloodstream, your blood vessels can become inflamed and block blood flow to your genitals. In fact, men with periodontal disease are three times more likely to experience erectile dysfunction than men with healthy mouths.

Signs of Poor Oral Hygiene

Poor oral hygiene manifests itself in a variety of ways. Including bleeding, swollen gums, toothaches, and abnormal growths. Here are some of the most common indicators that you aren’t brushing or flossing properly.

Tooth Pain

If you have tooth pain, the last thing you want to do is ignore it. Even if you immediately start brushing and flossing more, it’s likely that the pain will continue. Tooth pain is frequently the result of serious tooth decay. Once the decay reaches the tooth the only way to stop it is with a dentist’s help. Tooth pain can also be a sign of:

Chipped, broken, or fractured tooth
Ill fitting crowns
Abscess
Infection

All of which can begin to cause other dental and overall health problems.

Bleeding/Swollen Gums

Bleeding, swelling, and color changes in your gums are all indications of poor oral hygiene. There may be an underlying problem with your gum health. If you’re in the beginning stages of gum disease, only a dentist can find out for sure. Treating your gums will prevent the disease from spreading to the point that your gums recede and your teeth begin to fall out.

Changes In Your Tongue

Changes in the texture or color of the tongue indicate either poor oral hygiene or deteriorating oral health. Every single night, you must thoroughly brush your tongue. If you dread cleaning your tongue due to the gag reflex, use a tongue scraper instead. If you notice changes in your tongue after your nightly brushings, consult your dentist.

Growths

Some patients experience oral growths along their gums. Others don’t notice them until a dentist points them out. Finding and treating abnormal growths is very important. These growths can easily lead to oral cancer.

Bad Breath

Nobody enjoys bad breath. While you can try to use gum or mints to mask it, taking care of your teeth is the best way to prevent it. When you don’t brush or floss properly food particles can get stuck in your mouth and create the odor. Even when not eating, a sticky film of bacteria called plaque will begin to form on your teeth which will also cause bad breath. This plaque will irritate your gums and ultimately lead to tooth decay.

Improving Your Dental Health

After all of that, you’re sure to want to start taking better care of your mouth and you can start immediately.

Brush your teeth 2x a day – Brush with fluoride toothpaste and a soft bristled toothbrush. This helps remove plaque and bacteria from your gum line. Make sure to brush every surface of your teeth including the backs and sides.
Floss 1x a day – Brushing alone won’t reach all of the spaces between your teeth. To get to those areas you’ll want to take about an 18 inch piece of floss, wrap it around your middle fingers and use your thumb and forefingers to slide the floss between each tooth.
Brush your tongue – Your tongue essentially acts like a sponge for bacteria. When you brush your teeth you’ll want to brush your tongue as well. Using either a toothbrush or tongue scraper.
Use mouthwash daily – Antibacterial mouthwash will stop harmful bacteria from growing. It also helps get rid of food and plaque that is stuck to your teeth.
Quit smoking – Tobacco use is the leading cause of periodontal disease and oral cancer. These products are best avoided altogether. If you currently smoke and wish to quit, consult your healthcare provider about available treatment options.
Visit your dentist regularly – Exams and cleanings of the teeth on a regular basis are essential for good oral health. Many patients benefit from six-month visits. However, if you are prone to cavities, gum disease, or other oral health issues, you may need to visit your dentist more frequently.

Working With EZ

Dental insurance may not always appear to be necessary. However, it is, because dental health can impact overall health. Gum disease, if left untreated, can lead to heart problems, strokes, and respiratory issues. Having dental insurance will allow you to maintain a healthy mouth and body without worrying about costly medical bills. To begin searching for dental insurance, please enter your zip code below or call one of our licensed agents at 877-670-3557.

Cost Sharing Reductions: Do You Qualify?

A cost-sharing reduction is a discount that reduces your deductibles, copayments, and coinsurance. They help reduce your out-of-pocket health care costs. Individuals qualify for health insurance coverage through the ACA Health Insurance Marketplace. Approved individuals receive discounts to assist with their deductibles, copayments (copays), and coinsurance, and to reduce their maximum out-of-pocket expenses for covered medical expenses.

Whether you qualify for these discounts depends on the size of your household and your income. As well as the plan you choose, since the only plans that have cost-sharing reductions are Silver plans. Your eligibility is determined when you enroll in your health plan.

How Cost-Sharing Reductions Work

Cost-sharing reductions reduce the amount of out-of-pocket expenses that you’re responsible for, thus making your insurance more affordable. Under Obamacare, anyone who qualifies for these discounts will have altogether lower out-of-pocket expenses when they apply for a Silver plan on the Marketplace. Any copayments, coinsurance, or deductibles associated with the plan you choose will decrease. They also increase the actuarial value of the plan.

We’ve given examples of these discounts below. However, it is important to note that the amounts below are just to show you how they work. The actual costs and discount will vary depending on the plan you choose and your income. Keep in mind that there is a large variety of deductibles, copay, coinsurance, and out-of-pocket maximums across all plan categories.

Lower Deductible

A lower deductible means that your insurance company will begin to pay its portion of your medical expenses much sooner. For instance, if you choose a Silver plan with a $750 deductible. You are responsible for the first $750 of medical expenses. Once you’ve met the deductible your plan begins paying its portion. However, if you qualify for a cost-sharing reduction, that $750 deductible could turn into a $300-$500 deductible.

Lower Copays or Coinsurance

Copayments are the payments you make each time you receive care. Such as $30 for a doctor’s appointment. If your copay under your Silver plan is $30 and you qualify for the discount then you may end up only having to pay $15 instead.

Lower Out-Of-Pocket Maximum

An Out-of-pocket maximum is the total amount you would have to pay in a year for healthcare. With a cost-sharing reduction your plan’s out-of-pocket maximum could go from $5,000 to $3,000. Meaning you’ll effectively have much less to pay per year.

Silver Loading

Historically, the federal government reimbursed health insurance companies directly for cost-sharing reductions. This ended in the fall of 2017, but eligible enrollees have continued to receive cost-sharing subsidies.

Most insurers simply add the cost of cost-sharing reductions to Silver plan premiums to cover the expense. This strategy, known as “Silver loading,” results in larger premium subsidies for everyone in the area, as premium subsidies are based on the cost of the second-least expensive Silver plan in each area.

Cost-Sharing Tiers

The Silver Plan standard covers 70% of your out-of-pocket expenses. If you are eligible for cost-sharing reduction, you may be eligible for the Silver 73, Silver 87, or Silver 94 plan. The Silver 73 plan covers 73% of your out-of-pocket expenses, 3 percent more than the standard Silver plan. However, if you qualify for a Silver 87 or Silver 94, you will receive coverage for 87% or 94% of your out-of-pocket expenses, which is 17% or 24% more than the standard Silver Plan. Rarely would it make sense for cost-sharing reduction-eligible individuals to purchase the Gold Plan. If you are eligible for the Silver 87 or 94 plan but choose the Gold plan, you will pay higher premiums for fewer benefits. The Silver 94 plan is superior to the Platinum plan, which covers 90% of out-of-pocket expenses.

Who Qualifies For Cost-Sharing Reductions?

Cost-sharing reductions are available to eligible Marketplace enrollees who select Silver plans. Your household income needs to be below 250% of the federal poverty level (FPL). In states that did not expand their Medicaid, the lower income threshold is 100% of the poverty level, while in states with expanded Medicaid the lower income threshold is at 138% of the FPL. If your income is low enough to qualify for Medicaid you will not be eligible for a cost-sharing reduction. Additionally you must be a citizen or an immigrant who has lived here legally for at least 5 years.

Native American Cost-Sharing Reductions

Cost-sharing reductions work a little differently for Native Americans. Members of federally recognized Indian tribes receive an additional set of cost-sharing advantages. As long as their household income is less than 300 percent of the Federal Poverty Limit, these households qualify for zero cost-sharing plans. These plans have no copayments, deductibles, or coinsurance when receiving care from an Indian healthcare provider or any of the Marketplace’s essential health benefits.

What Is An Actuarial Value (AV)?

The AV of a plan is the average percentage of total healthcare costs that the plan will cover. A consumer enrolled in a Silver plan with a 70% AV would be responsible for paying an average of 30% of their actual healthcare costs, with the insurer covering the remaining 70%. Since these actuarial values are based on the average number of enrollees, the actual percentages for each household will vary considerably based on their total healthcare costs. In general, the lower your expected healthcare costs, the lower the AV value, as you are responsible for the deductibles prior to the insurer picking up the tab.

How To Apply For a Cost-Sharing Reduction

If you are eligible when you apply for a Silver plan you are automatically enrolled with the cost-sharing reductions built into your plan. Therefore, the lower out-of-pocket maximum and higher actuarial value are automatic as long as you choose a Silver plan. You will only see Silver plans with the cost-sharing reductions built in if you are eligible for them. If you have a higher income you will only be shown standard Silver plans.

If I’m Eligible for a Cost-Sharing Reduction, Is A Silver Plan Best For Me?

There is no correct or incorrect response. A person earning 240% of the poverty level and a person earning 140% of the poverty level are both eligible for cost-sharing reductions benefits, but they will receive vastly different benefits. If your income falls within the range where the plan’s AV will only be increased to 73%, it may be prudent to enroll in a less expensive Bronze plan, saving money on premiums (or even getting a plan for free) in exchange for slightly higher out-of-pocket costs.

Depending on your income and location, it is also possible for you to qualify for a Gold plan with no premium. You would need to compare this carefully with the available Silver plans and their built-in cost-sharing reductions benefits, taking premium differences into account.

But if your income is on the lower end and you’re eligible for strong cost-sharing reductions benefits (i.e., your income is under 200% of the poverty level), you should strongly consider the Silver plans that are available to you, even if there are free Bronze plans available as well (if your income is under 150% of the poverty level, you’ll also be eligible for premium-free Silver plans with built-in cost-sharing reductions benefits in most states). Consider the amount of out-of-pocket expenses you will incur if you require medical care during the year. It will be significantly higher on the Bronze plan, which could quickly wipe out any savings from the lower monthly premiums.

What If My Income Changes?

If your income changes after enrollment and makes you eligible or ineligible for cost-sharing reductions, you will be able to change your plan during a Special Enrollment Period (SEP). However, this option is only available if you were previously enrolled in a Marketplace plan or Medicaid. If you chose to enroll in a health insurance plan outside of the Marketplace, you will not be eligible for a SEP.

If I Don’t Qualify, Are There Other Assistance Options?

Even if you do not qualify for cost-sharing reductions, you may still be eligible for premium tax credits to assist with your health insurance costs. Premium tax credits are a type of subsidy that reduces your monthly premium payments and are available to those with incomes between 100 and 400 percent of the federal poverty level. This means that if you qualify for cost-sharing reductions, you will likely also be eligible for premium tax credits and be able to reduce your health insurance costs further.

Working With EZ

If you qualify for a cost-sharing reduction, the amount of money you will save is determined by your specific income estimate. The lower your income, the greater your savings. Once you speak with an EZ.Insure agent, they will determine if you qualify for additional discounts. As well as guide you in the right direction. Our highly trained and knowledgeable agents will assist you in shopping, comparing, and enrolling in the best plan for you or your family. We guarantee to help you save money without requiring you to deal with multiple agents and companies. We simplify the process for you. Enter your zip code below to receive free instant quotes, or call 877-670-3557.

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Physical Health

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