Humana Off-Exchange PPO for most of Texas

[MBSC]

Humana will be offering an off-exchange Bronze level PPO with HSA in most Texas counties for 2016.

Name: Humana Bronze 6450/ChoiceCare PPO

In-Network Deductible: $6450/$12900 Individual/Family
"PPO plans use our national medical network of hospitals, doctors and specialists."

Embedded Deductible: Yes. An individual covered family member will receive coinsurance benefits once they have met their individual deductible.

In-Network MOOP: $6450/$12900

HSA Eligible: Yes

Available in all counties EXCEPT:

Austin, Bastrop, Bosque, Brazoria, Burnet, Caldwell, Chambers, Colorado, Falls, Fayette, Ft. Bend, Galveston, Grimes, Hamilton, Harris, Hays, Lee, Liberty, Limestone, Milam, Montgomery, Travis, Waller, Washington, Wharton, Williamson

Plan Brochure: http://apps.humana.com/marketing/documents.asp?file=2589964

 

[MichaelB]

Good tip, thanks.

That looks like a lot of counties. Hopefully the Humana policy will be a good options for folks in the Lone Star State.

Humana's tool to search their network is not bad (here). You can generate pdf lists and easily expand or contract the search area. The network in this plan is national.

 

[audreyh1]

Humana will be offering an off-exchange Bronze level PPO with HSA in most Texas counties for 2016.

Name: Humana Bronze 6450/ChoiceCare PPO

In-Network Deductible: $6450/$12900 Individual/Family
"PPO plans use our national medical network of hospitals, doctors and specialists."

Embedded Deductible: Yes. An individual covered family member will receive coinsurance benefits once they have met their individual deductible.

In-Network MOOP: $6450/$12900

HSA Eligible: Yes

Available in all counties EXCEPT:
Plan Brochure: http://apps.humana. a Humanacom/marketing/documents.asp?file=2589964

This was the one I had located earlier when I had considered my options before open enrollment. I mimicked a change of coverage situation to get quotes. This was the option that came up for my county. It also looked as if my main doctor was covered by this, and HSA compatible as well.

I was just hoping it would still be available once the open enrollment period arrived.

Interesting that Central Texas and Houston area are not covered by this PPO.

I guess there are more changes expected in the future with the Aetna purchase.

One year at a time.

 

[MBSC]

Interesting that Central Texas and Houston area are not covered by this PPO.

It appears they are sharing Texas. That area is covered by off-exchange Cigna 'Vantage' EPO plans connected to a national network.

The LocalPlus Network provides access to health care professionals in your area and other parts of the country. When you receive care from a health care professional or hospital in the LocalPlus Network, the visit is considered in-network which helps you incur lower out-of-pocket expenses.

Cigna contracts with the LocalPlus Network of health care professionals to ensure that you have referral-free access to quality care and to help keep your health care costs lower. When traveling, visit LocalPlus professionals in other LocalPlus Network areas for in-network benefits. If outside of a LocalPlus Network area, access the Cigna Open Access Plus (OAP) Network for in-network benefits.

To find out if your health care professional is included in our network, please visit www.Cigna.com/ifp-providers.

Cigna Texas overview (It takes a while to load): www.cigna.com/assets/docs/individual-and-families/2016/pblink-medical/cm/888418-localplus-ss-network-flyer-tx.pdf

 

[ziggy29]

For giggles and grins, I priced this one, unsubsidized, for someone in my situation (male, age 50, nonsmoker).

This *bronze* Humana PPO was quoted at $504.58.

The unsubsidized Marketplace plans (all HMOs) ranged from $301-355 for bronze, the silver from $396-447 and the gold from $485-560. In other words, this bronze plan was more expensive than every silver plan, and one *gold* Marketplace HMO plan was cheaper than this one by about $16 a month.

So it looks like the cost of avoiding an HMO is around $150-200 a month, at least at my age.

 

[audreyh1]

For giggles and grins, I priced this one, unsubsidized, for someone in my situation (male, age 50, nonsmoker).

This *bronze* Humana PPO was quoted at $504.58.

The unsubsidized Marketplace plans (all HMOs) ranged from $301-355 for bronze, the silver from $396-447 and the gold from $485-560. In other words, this bronze plan was more expensive than every silver plan, and one *gold* Marketplace HMO plan was cheaper than this one by about $16 a month.

So it looks like the cost of avoiding an HMO is around $150-200 a month, at least at my age.

Prices also vary by county, I believe.

 

[BarbWire]

It appears they are sharing Texas. That area is covered by off-exchange Cigna 'Vantage' EPO plans connected to a national network.

SCGamecock -- thanks for posting this.

How did you find it? I tried looking at HealthSherpa for off-exchange policies in 78731, and Cigna didn't come up.

Should I be looking at another website to find the off-exchange offerings?

 

[Katsmeow]

Sigh. The kids and I have been on DH's retiree medical coverage (he is on Medicare). The group PPO premium was going up and up so Megacorp has now switched us all to individual marketplace or off marketplace plans. They are contributing quite a bit to the premium cost which is fine particularly as the premiums are lower anyway.. But....

The narrow networks and lack of PPOs is a big issue. The huge deductibles and out of pocket isn't great, but is OK given the lower premiums. Still I don't like having mostly hospitals I've never heard of and especially not having any out of network access. When I saw this thread I thought it might be an option....

Then I saw I was in one of the excluded counties.

 

[MBSC]

SCGamecock -- thanks for posting this. How did you find it? I tried looking at HealthSherpa for off-exchange policies in 78731, and Cigna didn't come up. Should I be looking at another website to find the off-exchange offerings?

You're welcome. I found it through an independent agent/broker. I did not know HealthSherpa listed off-exchange plans unless you signed in as an agent. For off-exchange plans, you can use a broker or go directly to the insurance company's website.

I converted zip 78731 to Travis County and linked the Cigna Vantage plans below. When you click 'view plan details', click 'Network Details' tab, and read the fine print about the LocalPlus Network with local and out-of-area coverage.

Texas Health Insurance Plans and Coverage Options | Cigna

The narrow networks and lack of PPOs is a big issue. When I saw this thread I thought it might be an option....Then I saw I was in one of the excluded counties.

Did you see post #4 above for the Cigna EPO plans? I'm no expert on Texas, but it seemed to cover the areas omitted by Humana.

Nationwide EPO: No referrals, no PCP, emergency care covered, you pay non-network providers for non-emergency care.
Nationwide PPO: Same as above except you pay non-network providers for non-emergency care...until the high deductible is met.

 

[Fermion]

The cost of a PPO being $150 a month more than an HMO seems worth it if you plan on travel. A nationwide network seems a lot better than only local coverage. A lot of PPO plans also provide at least some coverage of out of network (like 50% co-pay) where I have yet to find an HMO that covers anything out of network except emergency care.

 

[MichaelB]

EPO vs PPO

All BCBS individual plans in Florida are called EPO, some of the literature still says PPO and their agents all say PPO. When I called to ask about this their answer was that the policies had children's dental and vision (ACA requirement) and coverage for those services was limited to a smaller network of providers. The rest of the policy coverage was the entire network, like a traditional PPO. The literature used the term EPO because one (small) piece was not PPO.

 

[MichaelB]

Sigh. The kids and I have been on DH's retiree medical coverage (he is on Medicare). The group PPO premium was going up and up so Megacorp has now switched us all to individual marketplace or off marketplace plans. They are contributing quite a bit to the premium cost which is fine particularly as the premiums are lower anyway.. But....

The narrow networks and lack of PPOs is a big issue. The huge deductibles and out of pocket isn't great, but is OK given the lower premiums. Still I don't like having mostly hospitals I've never heard of and especially not having any out of network access. When I saw this thread I thought it might be an option....

Then I saw I was in one of the excluded counties.

The major insurers have introduced separate policy offerings that are marketed directly to the consumer or through brokers. The only way to see them is directly on their website. The policies are ACA compliant, but are not eligible for premium assistance. Hopefully you can find one among them.

 

[BarbWire]

I found it through an independent agent/broker. I did not know HealthSherpa listed off-exchange plans unless you signed in as an agent. For off-exchange plans, you can use a broker or go directly to the insurance company's website.

Ah, my mistake. I thought HealthSherpa covered both. Thanks!

My head hurts, and it's only November 6th ....

 

[Animorph]

I made a list of all the insurers available to me on Healthcare.gov and then went to the website of each one. A similar Humana plan turned out to be available to me off marketplace.

While the out of network benefit is nice, it is not terrifically useful for everyday use. The deductible is twice as high as for in network, and I would assume the two deductibles are independent. The OOP is even worse. So it's not like you can hop on over to an out of network provider and get Humana to pay anything, or even bump your in network deductible payments. It's only useful if you have a major health event, decide your best option is out of network, and don't mind paying tens of thousands of dollars more for your treatment.

I'm thinking of going with a cheaper HMO plan that does not require referrals. I'll continue to see my current PCP doctor, who is out of network but says he'll work with me on his cost. That'll be a few hundred bucks that won't be credited to my in network deductible, and relatively limited on the high side. My specialists are mostly in network. This year I might actually exceed my deductible, but probably not next year.

If my total is less than the deductible, then I haven't lost anything. If I exceed the deductible then I'm out a few hundred bucks to my PCP that I would have recovered if he was in network. If something major occurs I'll have to stay within network.

 

[TheKrell]

In my research, as well as conversations with my agent, there are ONLY 2 companies in Texas offering Individual PPOs. Humana and Baylor / Scott & White.

I find HMOs to be far too restrictive and would not consider them at ANY price. Moreover, I think that HMOs may end up with providers that are "not the best".

Baylor has a good reputation in my area. However, I might sometimes need care outside the state of Texas. So presently, we are leaning towards Humana for our Texas PPO.

 

[Fermion]

I thought Texas had a Blue Cross Blue options PPO that was pretty much nationwide and what some Escapees RV travelers use that call Texas their home.

 

[audreyh1]

I thought Texas had a Blue Cross Blue options PPO that was pretty much nationwide and what some Escapees RV travelers use that call Texas their home.

BCBS of Texas dropped that for individual insurance.

For 2016 their PPO is only available through employer based insurance plans and pre-ACA grandfathered individual plans. The rest of us are canceled.

May not affect seniors on Medicare supplement plans - not sure about that.

 

[Fermion]

Wow, and to think we almost switched residency to Texas just to get that BCBS plan and an Escapees mail forwarding address.

 

[TheKrell]

I thought Texas had a Blue Cross Blue options PPO that was pretty much nationwide and what some Escapees RV travelers use that call Texas their home.

The comments in the post above (audreyh1) are essentially correct. Apparently, Blue Cross "wanted" to continue with individual PPOs in Texas.

But under Obamacare law, if they raised the rates on their individual Texas PPOs they would have been FORCED to raise rates on other plans as well to comply with the law.

They are allowed to continue with employer-sponsored PPOs and some older individual PPO plans that are grandfathered only because these have exemptions in Obamacare law.

 

[MBSC]

In my research, as well as conversations with my agent, there are ONLY 2 companies in Texas offering Individual PPOs. Humana and Baylor / Scott & White.

Allegian is another small player. They offer PPO's in Bexar (San Antonio), El Paso and Nacogdoches counties.

Texas Individual & Family Health Plans | Allegian Choice

 

[audreyh1]

The comments in the post above (audreyh1) are essentially correct. Apparently, Blue Cross "wanted" to continue with individual PPOs in Texas.

But under Obamacare law, if they raised the rates on their individual Texas PPOs they would have been FORCED to raise rates on other plans as well to comply with the law.

They are allowed to continue with employer-sponsored PPOs and some older individual PPO plans that are grandfathered only because these have exemptions in Obamacare law.

Well - that's their story anyway.

 

[Katsmeow]

The major insurers have introduced separate policy offerings that are marketed directly to the consumer or through brokers. The only way to see them is directly on their website. The policies are ACA compliant, but are not eligible for premium assistance. Hopefully you can find one among them.

Our situation is a little different. The kids and I have been insured through retiree insurance from the Megacorp DH retired from (he is on medicare).

They have contracted with a private exchange to offer us plans and they Megacorp gives us a set amount of money that we can apply to any insurance. As far as I can tell, with one exception, the plans offered are all the ACA compliant plans for the individual market. The have a listing of marketplace (exchange) plans and then a list of non-marketplace plans. Those are basically the plans you can buy directly from insurers. We can go direct to any insurer if we want and would still get the subsidy from Megacorp.

The big issue that is causing lots of consternation, of course, is the disappearance of individual PPOs in Texas. Megacorp was taken by surprise on this.

So, we were told previously that we would be able to get similar coverage through the exchance to the group PPO we had before but it would be cheaper.

The problems in Texas are not just the disappearance of the PPOs, it is the very narrow networks on the plans on the individual markets -- whether on or off exchange. We live near Houston and there are entire plans that don't any of the really good hospitals in the area. The plans are full of hospitals I've never heard of.

The best non-PPO option is the Cigna LocalPlus Network EPO. It was a really good network of hospitals with all of the major hospitals with one big, glaring exception. The exception is M.D. Anderson. A lot of people are really upset that you can't get any plan with M.D. Anderson in it. My husband is on traditional Medicare and he could go to M.D. Anderson if he got cancer. I would not be able to these non-PPO plans as it is not in network on any and there is literally no out of network coverage at all. This is a real problem for people who are getting treatment from M.D. Anderson that literally can't be gotten anywhere else. Here is an article that discusses the problem:

Loss of insurance plans could devastate cancer patients - Houston Chronicle

In our case, at this private exchange, we do have one PPO option which is based on the LocalPlus network. It doesn't show up on Cigna's web page so I guess it is some sort of group PPO that has been offered to us so we have at least one PPO.

But it is really limited in its out of network option. The deductible for a family is $25,000 and the out of pocket maximum is $50,000! But, it would theoretically allow you to go to M.D. Anderson out of network if it was a situation where they had the best treatment for something (of course, you would still be exposed to balance billing).

I don't like the idea of HMOs or EPOs because of the lack of out of network coverage. And, this one PPO is not so great. And, even the LocalPlus Network is much narrower than our current network. But, it is the best of the ones on offer.

 

[MBSC]

The best non-PPO option is the Cigna LocalPlus Network EPO. It was a really good network of hospitals with all of the major hospitals with one big, glaring exception. The exception is M.D. Anderson. A lot of people are really upset that you can't get any plan with M.D. Anderson in it. My husband is on traditional Medicare and he could go to M.D. Anderson if he got cancer.

+1
For anyone interested, the website below lists the Plan/Network combinations M.D. Anderson Cancer Center does accept. However, a lot of them, like the 'Humana National POS Open Access', are group/employer networks not available on individual plans.

Insurance Plans & Billing Information | MD Anderson Cancer Center

 

[ziggy29]

For anyone interested, the website below lists the Plan/Network combinations M.D. Anderson Cancer Center does accept. However, a lot of them, like the 'Humana National POS Open Access', are group/employer networks not available on individual plans.

Insurance Plans & Billing Information | MD Anderson Cancer Center

The cruel irony is that the Humana PPO is accepted by MD Anderson, but you can't even get it in the Houston area where the hospital is located.

It appears the individual PPO uses in the "Choice Care PPO" group which MD Anderson shows as accepting in this link.

I wonder if we may see people try to fake their home address and open a PO box where the PPO is sold.

 

[audreyh1]

This Humana PPO option is available to us. But it represents a large monthly price increase - like 55%!. When I compared three company's PPO options for 2014, Humana was the most expensive.

Yet - the 2016 price is just very slightly higher than what I paid in 2013 for a PPO when I was in the Texas Health Risk Pool. We've had two years of much lower insurance premiums. Now it looks like we'll be going back to what we used to pay – if we go this route.

I have to look carefully at what coverage I can still get under the new BCBS plans. Most of the doctors are still available in network. I don't have a problem with referrals in general, as long as I have unrestricted access to my gyn. But I worry about not having any coverage out of network.

Burning question for us - do we pay up for a PPO knowing that we'll have some level of coverage and a wide network plus out of network coverage if necessary, or do we hope we can manage within the more limited network with no out-of-network coverage and hope not have any nasty surprises.

That's were the whole question of "insurance" comes in. You don't know what might happen. All the cases of cancer that I know of, for example, could not have waited to start treatment. If some options are not available to you right off the bat, what can you do? I am very loath to take those kinds of risks.