The last couple of weeks, I’ve been talking about Marketplace coverage and subsidies. This week we discuss a Marketplace tip to leverage better coverage and one is: having a Marketplace subsidy as well as individual private or PPO insurance. The ending of the extended open enrollment period is almost here. Extended open enrollment is ending on August 15th, which means that from September 1st, you will need to wait until the end of the year to change/enroll in healthcare plans.
Marketplace is an important thing to consider because often people will think that they don’t qualify for subsidies, but once I plug in all their information, we find that they do. This is important to know about, especially for people who have private PPO insurance or an individual plan that allows them to be cash patients and get reimbursed.
Let’s take the example of one of my recent clients. They have an individual PPO plan that they pay the premium for. They also know they have a few upcoming surgeries. Once plugging in their information, we find that they can qualify for a subsidy and can be on the Marketplace plan with a zero deductible. Their doctors are in-network, and all they would have to pay are the copayments. So what I do for a client such as this, who already has a private PPO plan, is to keep them on that plan since they are already paying for it.
I am then going to get them on the Oscar plan Marketplace to have surgery done. Their copay is $1,300, which is really not bad for surgery.
The client uses the Oscar plan as their primary insurance with the doctor/facility. They do not give private PPO insurance. I advise them not to tell the facility or the surgeon that they have two insurances because it confuses them. Once Oscar pays, we take all the receipts from the surgeon, send them to the private PPO, and the client is going to get reimbursed the amounts that the plan pays for the surgery.
In some cases, the amount the PPO agrees to pay for the procedure is more than copayment – but not always. If you are a healthy person, not expecting any surgeries or procedures, this is not an avenue I would recommend. But, for others, there are all kinds of little tricks that people don’t even realize that we can do that are perfectly legal.
It is important to note that there is nothing illegal about having two different kinds of insurance. These are not both major medical plans.
It is based on everything that is happening right now with the Marketplace, and the subsidies offered.
If you need treatment, please reach out to me. I’m happy to look and see what plans you already have and what I can do to help. I can see if you qualify for a marketplace plan, or if you qualify for a private plan. I’m happy to review everything.
On my webpage, www.jkappconsulting, you can book an appointment with me. There are always very creative ways that I can use to help my clients save money. My goal is to save everybody money and not pay these outrageous amounts when you need to have a procedure or surgery done.