So how crazy am I...

[LARS]

The State (South Carolina) we're seriously considering for our next move offers only an EPO policy (Exclusive Provider*) in the Individual Health Insurance market.

Our exposure until Medicare is (1 year and 3 years). Both in very good health. Very minimal use of Healthcare to date.

Still, can't decide how crazy it is to take the EPO risk because of the "what if" issue. There are potential work arounds but they are a pain and potentially expensive.

Can't decide whether to roll the dice until 65 or pick another State...


* EPO means zero coverage/negotiated rates outside of Network

 

[broadway]

EPO is the only coverage that I can get here in NJ through the marketplace.


It's been like that since it began.


.

 

[Dtail]

Perhaps check out the breadth of doctors included in the EPO coverage. If extensive enough, I would probably go for it. I assume you don't wish to move twice.

 

[MichaelB]

The BCBS policies in Florida were originally termed EPO, now they're called EPO / PPO. I spoke with an agent a couple of years ago about this and he explained the medical part of the policy was pure PPO and used the same BlueCard national network. However, the policy also had pediatric dental coverage (ACA requirement) and they used a smaller, closed EPO network, so they had to classify the entire policy as EPO.

I wonder what the difference is between a policy with a small PPO network vs an EPO. The small PPO has a limited network, there is out of network coverage but only after a separate and super-high deductible has been met, and for out of network services there is no preferred price, which is a critical advantage of the insurance policy. It doesn't seem much worse than an EPO.

 

[LARS]

The BCBS policies in Florida were originally termed EPO, now they're called EPO / PPO. I spoke with an agent a couple of years ago about this and he explained the medical part of the policy was pure PPO and used the same BlueCard national network. However, the policy also had pediatric dental coverage (ACA requirement) and they used a smaller, closed EPO network, so they had to classify the entire policy as EPO.

I wonder what the difference is between a policy with a small PPO network vs an EPO. The small PPO has a limited network, there is out of network coverage but only after a separate and super-high deductible has been met, and for out of network services there is no preferred price, which is a critical advantage of the insurance policy. It doesn't seem much worse than an EPO.

Actually spoke with Florida Blue (the other state we're considering). Their policies are traditional PPOs. The EPO only refers to a few specific services that they do through an EPO, which is basically Florida Blue exclusive use of Quest Diagnostics.