Before you begin searching for an ACA plan, it's important to understand managed healthcare plans and how they work.

When I'm speaking with clients, they often have questions regarding the types of plans available through the ACA. Then the next sentence is usually followed by several garbled acronyms, frustration, and then a genuine desire to understand what managed health care is and how the type they choose impacts them.

ACA health plans vary in type by where you live and resources available in your community. According to Healthcare.gov, there are a variety of insurance and network types available to consumers. "Network" is a word you will want to memorize, as most ACA coverage is offered through Manage Healthcare Organizations through their contracted network of providers. Most managed plans do not cover treatment unless its provided by a physician in their network. Never assume the doctor you've seen for the last 10 years is in network before verifying first or you'll most likely be stuck with 100% of the bill. However, if you're traveling out of your local area or out of the country, emergency and medically necessary treatment is covered.

According to Healthcare.gov, network plans that consumers will find on the marketplace are.

• Exclusive Provider Organization (EPO): An EPO is a managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency). These plans are more restrictive and are common in areas where there's limited services available. Additionally, EPO plans might be something offered through a local health provider to it's employees that limits coverage to their own local network. Any treatment, without prior approval, is not covered by the plan.

  
  

• Health Maintenance Organization (HMO): An HMO is one of most common ACA plans. HMOs also typically limit coverage to providers within their network. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness. An HMO will cover emergency and medically necessary care when traveling out of your network or out of the country.

  
  

  • HMOs are the type of networks available in Southeastern Virginia . They provide focus on prevention and wellness through requiring you to choose a Primary Care Physician (PCP), or one is assigned to you. This means that you see the same doctor each time you need treatment. Your PCP also typically performs your annual preventive care physical, which all ACA plans cover at no cost to the consumer. HMO plans are designed to get the consumer involved in taking an active part in their health and wellness, preventing health events from becoming major or life threatening. Seeing the same primary care physician allows them to build a report with you and offer you the optimal treatment for your personal needs.

  • HMO managed care helps save out of pocket costs for in-network services as their fees are negotiated with member providers, incentivizing members to use their network. Remember, unless you have a medical emergency out of your network area, or out of the country, services are likely to NOT be approved and will be 100% your responsibility.

  • Last, healthcare providers invest significant amounts of resources into their proprietary online and mobile apps to help you be a part of managing your own healthcare. While all providers offer live agents to assist you, many simple questions or changes may be easily done online or through the providers phone app. I always encourage and help my clients get their online accounts setup immediately. This allows consumers to easily find in network providers, make and track appointments, file claims, seek pre-authorization for procedures and medications, set up premium payments, and help consumers take full advantage of the benefits available to you.

    
    
    
    

• 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. PPO plans are typically desired by consumers that prefer to choose their providers, regardless of their network affiliation, while providing less restrictions for covered treatment.