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OVERWHELMING. Your head might be reeling trying to comprehend all the insurance changes: learning the jargon, comparing prices, and understanding exactly what you're getting. That's why we talked to our insurance broker, Jim Marsh, of Hofgard Insurance. Jim and his staff are certified by the ACA to answer questions and help people sign up for insurance. As Jim said, this is a work in progress, and he expects continued evolution of the rules over the next several months. But as of now, here are some things you need to know.
Since many of you are interested specifically in physical therapy benefits, I'll share what I know. I'll also give you some general information to help you transition to ACA -sanctioned health insurance.
Insurance is not going to be less expensive for most people. Unless you qualify for a subsidy, insurance will likely be more expensive, but also much more comprehensive. Some of the required changes that affect the physical therapy you receive include:
- No exclusion for pre-existing conditions.
- Up to 40 visits in outpatient physical therapy per year.
- Wellness and prevention services and chronic disease management services must be provided.
There are several levels of plans: Bronze, Silver, Gold and Platinum. In ascending order, each pays a greater percentage of the fee for service and comes with a higher premium. Oddly, they all have the same maximum out of pocket expense. SO, while with the Platinum Plan you pay only 10% out of pocket, your monthly premium will be much higher. As with all plans, when you reach $6350 out of pocket expense, your insurance will pay at 100% for any in-network services. You'll have to do the math to see what makes the most sense for you.
Within the Colorado exchange, ALTA Physical Therapy is in-network for Colorado HealthOp and Rocky Mountain Health Plans. Each of these plans has different "metal" options within the plan. Each option offers 40 PT visits per year and covers 50% of the visit, after the deductible has been met. This sounds like a hefty percentage to pay for PT, but if, for example, you have had surgery, you will likely have met your maximum out of pocket for the year, and your PT visits will be covered at 100%. For any questions, check the Connect for Health Colorado website.
If you need additional help, do what we did and talk to one of the friendly and knowledgeable staff at Hofgard Insurance. Happy shopping.
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