Health Boards
Thu-11-12-2014, 20:17 PM
(This post was last modified: Thu-11-12-2014, 20:18 PM by Kat. Edited 2 times in total.)
Insurance in the States can be quite complicated, so this is a general guide to help those wanting information.
First, the new Affordable Care Act (aka ObamaCare). The official site is at: healthcare.gov
Through the Marketplace, people who previously couldn't afford insurance should be able to find a plan that fits there needs. Some states have their own Marketplace while others use the one set up by the Federal Government. This link provides where you would need to go (by state) to access the Marketplace.
obamacarefacts dot com/state-health-insurance-exchange
You can also call your local governement agency for information (usually through Family and Children Services) or through this site:
localhelp.healthcare dot gov
and also by calling the marketplace helpline at 1-800-318-2596.
Enrollment is November 15, 2014 - February 15, 2015.
For people who are able to acquire health insurance via their workplace, your human resource department is the best place to start for information. One thing that continues to confuse people is whether they want an HMO plan or a PPO plan (depending on what is offered, there are many different plans available so it's impossible to cover them all). So if you have a choise between HMO or PPO, this short description may help.
HMO - Health Maintenance Organization. This plan is where doctors either work or contract for the HMO. You are usually required to only see doctors within the HMO network (unless it's an emergency.) You usually are required to have a PCP (Primary Care Physician) who will refer you to other doctors as needed. Premiums are usually lower for HMO plans. Your deductible and co-pays are also usually lower but you may not have an out of pocket limit.
PPO - Preferred Provider Organization. With a PPO you do not have to have a PCP (Primary Care Physician) and you pay less if you use doctors within the PPO network. But you are not limited to certain doctors (however, if you go out of network you will most likely pay more and MAY have to file the claim yourself, always ask!) The deductible usually runs a bit higher but there is also (usually) a limit on your out of pocket expenses. You also are not required to have a referral from your doctor to see another physician.
That is the general difference between the two most common health plans. I used the word "usually" a lot as there are so many plans available, there isn't a "one size fits all" answer.
Medicare Insurance is available at age 65 or sooner if you are declared disabled by the government. Their website is:
medicare dot gov
Also, Fred had this information posted, adding it to this post since it's great info:
Adalimumab - Humira Say on their website "If you cannot afford your medication, contact:
pparx dot org or call the toll-free phone number (1-888-4PPA-NOW) for assistance.
Etanercept - Enbrel Have a dedicated payment support page:
enbrel dot com/pay-for-ENBREL.jspx
Ustekinumab – Stelara Also have a dedicated payment support page:
janssenprescriptionassistance...assistance
First, the new Affordable Care Act (aka ObamaCare). The official site is at: healthcare.gov
Through the Marketplace, people who previously couldn't afford insurance should be able to find a plan that fits there needs. Some states have their own Marketplace while others use the one set up by the Federal Government. This link provides where you would need to go (by state) to access the Marketplace.
obamacarefacts dot com/state-health-insurance-exchange
You can also call your local governement agency for information (usually through Family and Children Services) or through this site:
localhelp.healthcare dot gov
and also by calling the marketplace helpline at 1-800-318-2596.
Enrollment is November 15, 2014 - February 15, 2015.
For people who are able to acquire health insurance via their workplace, your human resource department is the best place to start for information. One thing that continues to confuse people is whether they want an HMO plan or a PPO plan (depending on what is offered, there are many different plans available so it's impossible to cover them all). So if you have a choise between HMO or PPO, this short description may help.
HMO - Health Maintenance Organization. This plan is where doctors either work or contract for the HMO. You are usually required to only see doctors within the HMO network (unless it's an emergency.) You usually are required to have a PCP (Primary Care Physician) who will refer you to other doctors as needed. Premiums are usually lower for HMO plans. Your deductible and co-pays are also usually lower but you may not have an out of pocket limit.
PPO - Preferred Provider Organization. With a PPO you do not have to have a PCP (Primary Care Physician) and you pay less if you use doctors within the PPO network. But you are not limited to certain doctors (however, if you go out of network you will most likely pay more and MAY have to file the claim yourself, always ask!) The deductible usually runs a bit higher but there is also (usually) a limit on your out of pocket expenses. You also are not required to have a referral from your doctor to see another physician.
That is the general difference between the two most common health plans. I used the word "usually" a lot as there are so many plans available, there isn't a "one size fits all" answer.
Medicare Insurance is available at age 65 or sooner if you are declared disabled by the government. Their website is:
medicare dot gov
Also, Fred had this information posted, adding it to this post since it's great info:
Adalimumab - Humira Say on their website "If you cannot afford your medication, contact:
pparx dot org or call the toll-free phone number (1-888-4PPA-NOW) for assistance.
Etanercept - Enbrel Have a dedicated payment support page:
enbrel dot com/pay-for-ENBREL.jspx
Ustekinumab – Stelara Also have a dedicated payment support page:
janssenprescriptionassistance...assistance