Category: Open Enrollment

Open Enrollment, Mattoon Illinois

What is the difference between an HMO and a PPO health plan?

With the market place now being in full swing of things, when you are shopping for health insurance you are going to see the main two types of a policies: HMO and PPO. What is the difference between the two? We will answer that below!

A health maintenance organization (HMO) and a preferred provider organization (PPO) have a good amount of differences such as what doctors a patient can see, how much care costs and how important medical records are kept.


  • Choice of Health Care Provider

The PPO policy offers you more of a choice and flexibility, but with that comes a higher premium. With a PPO, you are able to see any doctor you wish or visit hospital you choose, within a preferred network of providers. Also with a PPO you do not have to designate a primary doctor and usually see a specialist without referral.

With a HMO policy, it requires you to only see doctors and hospitals on their list of providers. Which means you will need to choose a primary care doctor who will direct care and refer you to approved specialists if one is needed. This option does offer fewer choices and may make switching doctors or getting a second opion a little harder. Most the time, the HMO wil not cover medical expenses that are incurred by seeing someone who is not contracted with the HMO, but usually will have defined coverage for Emergency situations when a patient is outside the normal coverage area.


  • Cost Difference

PPO does usually pay a percentage of a person’s medical expenses, with the patient paying the remainder of the balance. HMO’s generally have a set cost for each service, so you can plan accordingly.


  • Medical Records

PPO’s usually do not store medical records in one location because you have the option choose what provider you wish to go to. Wish in return can cause a good amount time hunting down all your records.

HMO’s now with you choosing a primary care provider, medical records are kept together within the organization. Also when you are referred to a differ provider/ specialist; any medical records are usually automatically forwarded on your behalf.

Contact us today and we will help you for FREE with your marketplace health insurance plan!


What You Need to Know About Open Enrollment for Health Insurance

It’s that time of year again!

It’s time to start thinking about your health insurance during the open enrollment period. If you want to buy individual or family health insurance for 2018 now is the time to do it. Today we’re sharing the 10 basic items to think about while you navigate the open enrollment period.

  1. The open enrollment period this year has been cut in half. The new dates for open enrollment are Nov.1, 2017 to Dec. 15, 2017. With coverage starting Jan. 1st, 2018.
  2. You need to sign up through open enrollment if you do not have health insurance from a different source such as –
  • Employer or Spouse employer
  • Government coverage (such as veterans, Medicare or Medicaid)
  • Over the age of 26 and no longer on your parents
  • You qualify for tax credits
  1. This is the time to make changes to your current plan
  • You can renew your current individual/ family health insurance plan
  • You can choose a new health insurance plan through the market place
  • Make sure your Doctor and Hospital are still in your network
  • Check your drug plan, make sure pricing stayed the same
  1. If you miss open enrollment you may have to wait for a year to sign up, unless you have qualify for a special enrollment period, which includes: 
  • Divorce
  • Marriage
  • Birth or adoption of a child
  • Death of a spouse or partner that leaves you with not health insurance
  • Lose your job
  1. If you choose to ignore signing up for health insurance, the penalties/fees are as follows:
  • 5% of your income or $695 per adult (whichever is more)
  • Up to $347.50 per child
  • With the maximum being $2,085
  1. Once you are ready to choose a plan, you have four choice levels: 
  • Bronze- lowest premium/ highest out of pocket
  • Silver
  • Gold
  • Platinum – Highest premium/ lowest out of pocket
  1. All health plans must cover these 10 items:
  • Outpatient care including chronic disease management
  • Emergency care
  • Hospitalization
  • Pregenancy and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehabilitation services and devices
  • Lab tests
  • Preventive and wellness services
  • Dental and vision care for children
  1. Your family size and income determines your eligibility for tax credit. You can use this grid to find out whether you will be eligible for tax credits or not:
2017 federal poverty level guidelines (applies to 2018 coverage)
Persons in Household 2017 federal poverty level for continental U.S. Premium subsidy threshold (400% of federal poverty level)
1 $12,060 $48,240
2 $16,240 $64,960
3 $20,420 $81,680
4 $24,600 $98,400
5 $28,780 $115,120
6 $32,960 $131,840
7 $37,140 $148.560
8 $41,320 $165,280


  1. If you suffered a hardship, you may not be required to buy health insurance
  • Being uninsured for less than three months of the year
  • A close family member rently died or you had unexpected expenses related to caring for an elderly, ill or disabled family member
  • You have been evicted from your home or suffered bankruptcy
  1. The five ways to sign up
  • Phone
  • Mail
  • Online
  • In person with a certified attendant
  • Agent/ broker

Contact us today and and one of our Agents will help you sign up for health insurance! The best part? NO FEES! Make sure you choose the best plan for you and your family by setting up an appointment today with us.

Open Enrollment, Mattoon Illinois

2 Things You Should Know About Open Enrollment

It’s that time of year, your health insurance is up for renewal or you might be in the market for the first time.

The big question here is: Are you covered for your medical expenses? In central Illinois, the days are starting to get shorter and the weather is starting to get colder. The changing weather brings about flu and other types of seasonal sickness. This is the perfect time of year to diagnose your health insurance needs and understand the guidelines for enrolling into a health insurance policy.

So what are some things you need to know?

  • Timing is everything. If you enroll anytime before the 15th of each month, you will be covered the following month. So let’s say you enroll November 14th 2015, your policy will become effective December 1st, 2015.   Open enrollment will end February 28th, which means that if you wait until the last day to enroll into a health insurance, your policy will become effective April 1st, 2016.
  • Penalties. As of 2015, the penalty for not having health insurance is $325 for a single adult or 2% of your annual income, whichever is higher. As of 2016, the penalty is becoming steeper. The new penalty is $695 or 2.5% of your annual income, whichever is higher. However, this is not a fine and can only be taken from an individual’s tax return.

When it comes to insurance, many of us are guilty of procrastinating and waiting for the last minute. That’s why we have made it very easy for you to renew your plan or get enrolled!

How? We will help you enroll/renew, guide you through your options, and help you with any questions you may have –  FOR FREE! As always, you can stop by our Mattoon, IL office or give us a call at 217-235-2555 with any questions you may have.

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