Floyd Arthur Presentation - Families facing increased out of pocket health care costs in 2016 http://carmoongroup.com Out of network providers, on the other hand, do not negotiate with the insurer to charge a set fee; they charge any amount they choose. The insurer pays its negotiated cost,(the amount it pays in-network providers) and the patient pays the rest, up to a preset out of pocket annual spending cap (known as the maximum out of pocket expense, or MOOP.) As of 2016, however, that spending cap is – in many cases –going away. According to an analysis by the Robert Wood Johnson Foundation, 45 percent of Silver PPOs –the most popular option on the health insurance marketplace—have no spending cap on out of network costs in 2016. Further, many PPO health plans that have retained a maximum out of pocket limit have substantially increased the amount patients must pay. In Montana, for example, the 2016 Blue-Preferred Silver Plan offered by Blue Cross-Blue Shield has an out of network spending cap of $26,000 per individual and $52,800 per family. In Indiana, the bronze level PPO offered by Anthem caps out-of-network spending at $30,000 per individual and $60,000 per family. The mean out-of-network cap for an individual in the United States is in 2016 is $16,700, the Robert Woods Johnson Foundation reports. Floyd Arthur #floydarthur Business Insurance Hempstead New York http://floydarthur.info

1. FAMILIES FACING INCREASED OUT
OF POCKET HEALTH CARE COSTS IN
2016
By Floyd Arthur
http://www.Carmoongroup.com
http://www.Floyd-Arthur.com
Business Insurance Hempstead New York

2. AS IMPLEMENTATION OF THE
AFFORDABLE CARE ACT ENTERS ITS
SEVENTH CONSECUTIVE YEAR, AN

3. INCREASING NUMBER OF INSURANCE
PROVIDERS ARE REMOVING SPENDING
CAPS ON OUT-OF-

4. NETWORK HEALTH CARE COSTS IN THEIR
"PREFERRED PROVIDER" HEALTH
PLANS.FURTHER, MANY

5. PEOPLE WHO ARE CHOOSING THESE
PLANS ARE UNAWARE OF THE
CHANGE-A KNOWLEDGE GAP

6. THAT MAY LEAVE THOUSANDS OF
AMERICANS FACING ASTRONOMICAL
HEALTH CARE COSTS NEXT

7. YEAR.

8. HOW PPOS IMPACT HEALTH CARE
COSTS

9. TRADITIONALLY, PREFERRED PROVIDER
ORGANIZATIONS, OR PPOS, HAVE BEEN A
POPULAR OPTION FOR

10. FAMILIES WHO WANT FLEXIBILITY IN THEIR
CHOICE OF HEALTH CARE PROVIDERS AT
A REASONABLE

11. COST. UNLIKE LESS EXPENSIVE HEALTH
MAINTENANCE ORGANIZATIONS,
WHICHONLY COVER CARE

12. THAT'S PROVIDED BY A DESIGNATED
GROUP OF PROFESSIONALS, PPOS
ALLOW PATIENTS TO VISIT ANY

13. HEALTH CARE PROVIDER THEY CHOOSE.
DOCTORS WHO ARE "IN NETWORK"
PROVIDE CARE FOR A FIXED

14. COST THAT HAS BEEN NEGOTIATED WITH
THE INSURER. THE PATIENT PAYS A SET
PORTION OF THAT

15. COST (FOR EXAMPLE, A CO-PAY OF
$20) AND THE INSURANCE COMPANY
PAYS THE REST.

16. OUT OF NETWORK PROVIDERS, ON THE
OTHER HAND,DO NOT NEGOTIATE WITH
THE INSURER TO CHARGE

17. A SET FEE; THEY CHARGE ANY
AMOUNT THEY CHOOSE. THE
INSURER PAYS ITS NEGOTIATED

18. COST,(THE AMOUNT IT PAYS IN-NETWORK
PROVIDERS) AND THE PATIENT PAYS THE
REST, UP TO A

19. PRESET OUT OF POCKET ANNUAL
SPENDING CAP (KNOWN AS THE
MAXIMUM OUT OF POCKET

20. EXPENSE, OR MOOP.)

21. AS OF 2016, HOWEVER, THAT SPENDING
CAP IS - IN MANY CASES -GOING AWAY.
ACCORDING TO

22. AN ANALYSIS BY THE ROBERT WOOD
JOHNSON FOUNDATION, 45 PERCENT OF
SILVER PPOS -THE

23. MOST POPULAR OPTION ON THE HEALTH
INSURANCE MARKETPLACE-HAVE NO
SPENDING CAP ON

24. OUT OF NETWORK COSTS IN 2016.

25. FURTHER, MANY PPO HEALTH PLANS
THAT HAVE RETAINED A MAXIMUM OUT OF
POCKET LIMIT HAVE

26. SUBSTANTIALLY INCREASED THE
AMOUNT PATIENTS MUST PAY. IN
MONTANA, FOR EXAMPLE, THE

27. 2016 BLUE-PREFERRED SILVER
PLAN OFFERED BY BLUE CROSS-
BLUE SHIELD HAS AN OUT OF

28. NETWORK SPENDING CAP OF $26,000
PER INDIVIDUAL AND $52,800 PER
FAMILY. IN INDIANA, THE

29. BRONZE LEVEL PPO OFFERED BY
ANTHEM CAPS OUT-OF-NETWORK
SPENDING AT $30,000 PER

30. INDIVIDUAL AND $60,000 PER FAMILY.THE
MEAN OUT-OF-NETWORK CAP FOR AN
INDIVIDUAL IN THE

31. UNITED STATES IS IN 2016 IS $16,700,
THE ROBERT WOODS JOHNSON
FOUNDATION REPORTS.

32. BY CONTRAST, IN-NETWORK SPENDING
CAPS, WHICH ARE MANDATED BY THE
ACA, ARE $6,850

33. PER INDIVIDUAL AND $13,700 FOR A
FAMILY PLAN. THESE AMOUNTS INCLUDE
COPAYMENTS AND

34. DEDUCTIBLES.

35. HIDDEN HEALTH CARE COSTS LEAVE
FAMILIES FINANCIALLY EXPOSED

36. NOR ARE THE CHANGES IN THESE PPO
HEALTH PLANS EASY TO DISCERN. MOST
AMERICANS WHO

37. USE THE HEALTH INSURANCE
MARKETPLACE CHOOSE THEIR
HEALTH INSURANCE BASED ON

38. PREDICTABLE COSTS, SUCH AS
PREMIUMS AND DEDUCTIBLES. AND
WHILE HEALTH INSURANCE

39. PROVIDERS ARE REQUIRED TO DISCLOSE
OUT-OF-POCKET MAXIMUMS ON THEIR
WEBSITES, THESE

40. NUMBERS ARE OFTEN DIFFICULT TO
FIND.

41. FURTHER CONFOUNDING THE ISSUE IS
FACT THAT AFFILIATED HEALTH CARE
PROVIDERS ARE NOT

42. NECESSARILY IN THE NETWORKS OF THE
SAME HEALTH INSURANCE PLANS. FOR
EXAMPLE, A PATIENT

43. MAY HAVE A SURGICAL PROCEDURE
PERFORMED BY AN IN-NETWORK
PHYSICIAN AT AN IN-NETWORK

44. HOSPITAL AND STILL BE ON THE HOOK
FOR OUT-OF-NETWORK
ANESTHESIOLOGIST'S FEES. MORE

45. IMPORTANTLY, THE PATIENT RARELY
RECEIVES THIS INFORMATION IN TIME TO
MAKE AN INFORMED

46. DECISION ABOUT WHETHER TO PROCEED
WITH CARE. THE FIRST NOTICE MANY
FAMILIES RECEIVE IS

47. AN UNEXPECTED BILL.

48. THE CHOICE OF A HEALTH INSURANCE
PLAN IS ONE OF THE MOST IMPORTANT
DECISIONS YOU WILL

49. MAKE FOR YOU AND YOUR FAMILY. YET,
PARTICULARLY IF YOU ARE NOT INSURED
BY AN EMPLOYER,

50. THE DECISION IS BECOMING
INCREASINGLY MORE DIFFICULT TO MAKE
ON YOUR OWN. DON'T WAIT

51. UNTIL YOU FIND YOURSELF FACED WITH
TENS OF THOUSANDS OF DOLLARS IN
MEDICAL BILLS TO LEARN

52. ABOUT YOUR OPTIONS. CONTACT ONE OF
OUR INSURANCE EXPERTS TO SET UP AN
APPOINTMENT TO

53. REVIEW YOUR COVERAGE TODAY.CALL US
MONDAY THROUGH FRIDAY, 9 A.M. TO
6.P.M, AT 516-292-

54. 3780 OR REQUEST A FREE
CONSULTATION ONLINE NOW.

55. HEALTH CARE COSTS

56. HEALTH INSURANCE

57. HEALTH INSURANCE PLAN/S

58. GET YOUR FREE 30-MINUTE
CONSULTATION
Call Floyd Arthur
http://www.Carmoongroup.com
http://www.Floyd-Arthur.com
Business Insurance Hempstead New York