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Old 12-06-2015, 08:47 PM   #41
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HMO usually means a much more restricted network, which may not be a big deal if all your local doctors and facilities are part of it but can become a much more expensive deal if you're traveling somewhere and have a medical issue (such as an accident).

Avoid ACA repeal discussion, or take the risk that what some might consider to be reasonable talk about it will lead to quick thread locks.
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Old 12-07-2015, 04:47 PM   #42
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Another thing that bothers me about the other plans is that many have the 80/20 payments, so that you end up paying 20% of the cost, even perhaps after the deductible is met. Perhaps how people go broke with a health emergency even if they thought they had good coverage. At least with an HMO, anything in network is supposedly covered.
I think that ACA compliant plans have a max out of pocket. After that limit is reached, you're done paying until the next year. You pay $6,850, and after that, it's free. https://www.healthcare.gov/glossary/...maximum-limit/
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Old 12-07-2015, 08:45 PM   #43
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I felt that the lack of familiarity with HMO's expressed by some might be due to more than just being sheltered from insurance decisions through employer group plan availability, and found some data on the Kaiser family foundation's website that helps shed some light on that subject. Total HMO Enrollment | The Henry J. Kaiser Family Foundation Doing some calcs based on 2014 population estimates from Wikipedia shows the top 10 states for HMO market penetration are:

Hawaii 56.0%
California 51.1%
District of Columbia 44.1%
New Mexico 40.0%
Oregon 37.8%
Massachusetts 35.1%
Michigan 34.6%
New York 34.6%
Maryland 32.9%
Wisconsin 32.1%

And the lowest 10 are:

Mississippi 9.1%
Idaho 7.3%
Connecticut 6.9%
Oklahoma 6.8%
North Carolina 6.3%
Alabama 5.6%
North Dakota 4.2%
Vermont 3.7%
Montana 3.4%
Wyoming 1.8%

I became interested in the idea after finding a map indicating HMO market penetration rates for Wisconsin by county while searching for other insurance info. Even within the state there were very high variations by counties, generally it appeared as if the geographic areas with well established and regarded hospitals had the highest participation rates, 60% in some cases. For us in 2016 it is an HMO, as it was in 2015. Of 47 available marketplace plans in our zip, 33 are HMO, 10 EPO, and 4 EPS. Interesting to look at the data for other areas, as I can see why some are less familiar with HMO's.
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Old 12-07-2015, 09:04 PM   #44
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I just signed up my MIL who is 63. She got the cheapest silver plan for $19 per month (with a $798/mo subsidy). Her and her husband draw very minimal SS and it's just a thousand or so above the FPL so they barely qualify in this non-medicaid extension state of ours.

It's HMO with UnitedHealthcare. I took a quick look at the in network providers, saw a ton of PCPs in our ZIP. All the nearest 4-5 local hospitals are in network and tier 1, except the very closest one that's a "tier 2" (whatever that means). Not a big deal since the ambulances haul you to the larger slightly more distant major trauma center anyway (little risk of ending up at the tier 2 hospital where you pay more).

I didn't dive too deep into searching for other providers and specialists but it looked like a fairly broad network from a quick look.

$0 deductible, $500 max out of pocket. Low copays. Just a touch better than her being uninsured like she's been for the past several years.

In her case, she's paying $19 per month for a gold plated silver plan that's way better than the old policy she had pre-ACA for $350-400 per month.
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Old 12-07-2015, 09:32 PM   #45
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Originally Posted by sansha View Post
I signed up for a Blue Choice HMO, supposedly HSA eligible, with a 6500 deductible and a 372$ a month charge. Supposedly everything after the 6500$ deductible is covered.

Another thing that bothers me about the other plans is that many have the 80/20 payments, so that you end up paying 20% of the cost, even perhaps after the deductible is met. Perhaps how people go broke with a health emergency even if they thought they had good coverage. At least with an HMO, anything in network is supposedly covered.

.
First, I'd double check if you didn't get paperwork, we had issues and so its your responsibility to ensure its paid for and processed by Jan 1st.

Second, HMO vs PPO is really about size of network, that's it.

Third, the plans all have an out of pocket max with % based on High Deductible. Please note Out of Pocket max is different than deductible. Both are important to pay attention to as I've met my deductible and still owed money up to the max (deductible was $6500 and out of pocket max was $10,000). I had back surgery and therapy so even though I had met my deductible I was still paying all the co-pays for pain killers and therapy and such... so if I had hit my out of pocket max, THEN everything after would have been free.
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Old 12-07-2015, 10:35 PM   #46
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I think that ACA compliant plans have a max out of pocket. After that limit is reached, you're done paying until the next year. You pay $6,850, and after that, it's free. https://www.healthcare.gov/glossary/...maximum-limit/
This is what has happened with me this year. In my Silver plan, I have a max OOP of $6,450 which I reached thanks mainly to a 12-day hospital stay. Since I was released from there back in July, everything within the plan has been free. That includes in-network doctor visits, covered prescription drugs, and in-network labwork. Starting next year, everything gets reset to zero although I am switching to another Silver plan from a different company which has a different set of copays. The max OOP will become $5,900 but if I don't have to spend any more time in the hospital, I won't come anywhere close to $5,900 in OOP medical bills.
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Old 12-08-2015, 10:39 AM   #47
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My premium went up by 50%. My silver plan went up $20 per month and my subsidy has gone down by $20 per month with no change in income. Two years to Medicare, where I'll be paying much more!
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Old 12-08-2015, 06:11 PM   #48
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I took the cheapest option which was an HMO with $250 deductible and $2,250 max oop. $36 per mo premium. Limited to 8 counties in Pa. Had a much better deal last year but they dropped out. I ought to count my blessings because in 4 years I'll be joining the hammered medicare folks.
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Old 12-09-2015, 12:14 AM   #49
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Just signed up today....

Bronze with a high deductible close to max... $950 per month... about a 17% increase from last year... did not apply income so will be paying premiums out of pocket and getting back the money when filing for taxes... worth over $9 per month back from the CC company.... willing to take that until interest rates get back to normal....


Also signed for dental insurance.... had it last year, but not this year... but DW had a few problems and it cost me.... the net cost to me of the insurance is about $300 ish when you take into account the normal cleanings etc. that we always do... took the high option on this since they pay much more than the low option and it almost pays the difference in premiums for itself when you factor in deductibles....
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Old 12-09-2015, 11:28 AM   #50
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I nixed the ACA exchange healthcare this year, went with a bronze HSA directly from Regence.
I'll save taxes on the hsa plus I can draw out 19k from my IRA tax free.
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