HMO Patient vs Medicare Patient

            • Revenue changes
            • Cash flow
            • Administrative changes
            • Additional hands in the pot- they are                                             directing the stay, not you
            • New folks to market to

How does this affect the SNF’s?

~ Multiple ways - Again, it makes the pool bigger.                                                  People whose income is above 138% of the poverty                                          level and up to 400% will be eligible for subsidized                                            health insurance (Health Benefit Exchange) through                                          tax credits.

~ These patients will be now be insured and that also                                           means more managed care patients!

~ Managing managed care patients can be challenging                                        for Skilled Nursing Facilities if they are not used to                                            working with health plans or HMO’s.

~ Learn more about managed care and how Mix                                                    Solutions can offer contracting and consulting                                                    help to your facility.

​​What is The Health Benefit Exchange? 

~ The Health Benefit Exchange (HBE) is where individuals,                                                                   families, and small businesses can shop online for health                                                               insurance plans. They are a state-based health insurance                                                               market, which is also called exchanges.

~ The insurance plans can be compared side-by-side and an online calculator used to find         the best deal. Another feature of the HBE is that depending upon a person’s income,               there are some up-front discounts in the form of tax credits to help pay for the premiums     and some out-of-pocket assistance too.

~ As of April, 2014, over 7 million people had a selected health plan through health                    insurance marketplaces. 

~ Four Types of "metal plans" 

• Bronze
  
• Silver
  
• Gold
  
• Platinum
  

                                                                                                                                                                    ~ There are several choices among the plans with higher and lower deductibles, co-pays,           and higher or lower premiums. This also informs applicants if they qualify for premium         discounts and subsidies for out-of-pocket expenses. 

Health Care