Wheelchair users have many decisions to make when it comes to choosing healthcare plans: there are options both in employer-sponsored insurance and Medicare. This blog post is meant to be a helpful starting point for explaining a few of the mysteries behind health insurance plans as it relates to iBOT® coverage.
PPO vs. HMO
A PPO, short for Preferred Provider Organization, is a type of health plan that provides the maximum benefit when you use an in-network provider, but also provides coverage for out-of-network providers. An in-network provider is one that has a contract with the insurance company to provide services to their members. If you choose to use an out-of-network provider, who does not have a contract with the insurance company, you can expect to pay more out of pocket.
An HMO, short for Health Maintenance Organization, is a type of health plan that only provides benefits for in-network providers. Services from out-of-network providers are generally not covered. HMO plans generally have a lower out-of-pocket cost than PPO plans, but do not offer the same flexibility when choosing your practitioners and suppliers. Before choosing an HMO plan, check to make sure the providers you go to are in-network with the plan. You will pay more for healthcare over the year if your preferred provider is not in-network.
Traditional Medicare vs. Medicare Advantage
Traditional Medicare, also known as Original Medicare or Fee for Service, is health coverage managed by the Federal government. Medicare is available for people over 65 and certain people with disabilities. With traditional Medicare, you can visit any provider who accepts Medicare without worrying about a healthcare network.
Medicare Advantage is a health plan that replaces traditional Medicare. PPO and HMO plans are available as commercial Medicare Advantage plans. When looking at Medicare Advantage, remember that HMO plans generally restrict coverage to in-network providers, and that PPO plans have in-network and out-of-network coverage.
What this means for potential iBOT® users
Mobius Mobility started billing private insurances in spring of 2023. We are currently out of network with most plans but can obtain coverage for most individuals who have a PPO plan. Since most HMO plans lack out of network coverage, they will generally not offer any coverage for the iBOT®. If you have a choice in plans and are hoping for coverage of the iBOT®, we recommend choosing a PPO plan.
We are hoping to accept traditional Medicare and Medicare Advantage PPO plans soon. If you are thinking about changing your health insurance during open enrollment, you are likely to get the best coverage with Traditional Medicare (Part B). Medicare Advantage / Medicare Replacement PPO plans will also offer some coverage. Like private plans, Medicare Advantage HMO plans may lack out of network coverage, and therefore not offer any coverage for the iBOT®. If you are enrolling in Medicare and are hoping for coverage of the iBOT®, we recommend choosing Traditional Medicare Part B / Fee for Service.
It’s important to remember that healthcare is not one size fits all. If you need help choosing a health plan, there are resources available. If you get your health insurance through work, you should contact your human resources department for more information. Healthcare.gov can help when purchasing through the marketplace, and The State Health Insurance Assistance Program (SHIP) offers free assistance to beneficiaries enrolling in Medicare at www.shiphelp.org.
If you are interested in the iBOT®, and not sure where to start, check out our funding page! If you have further questions, email info@mobiusmobility.com to be connected with our community management team. We can’t wait to hear from you.
