Differences between PPO, EPO and HMO

[MRG]

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Originally Posted by Scuba I avoid HMO’s ... there is a reason they’re referred to as “managed care.” My doc said he interviewed with a major HMO years ago. They had very strict rules as to protocols, time spent with each patient, etc., and he said the drugs on their approved formulary excluded the newest, most advanced treatments.

I'm not sure that's just HMOs limiting the formulary. My PPO last year wanted my DM to come back from the beyond to swear I needed flowmax.

Last plan, similar from the same insurance company, no problem. Two years later, no deal. Prior approval? No, take these other medications first, step therapy. One was a made my BP 60/40, the other too dizzy to stand up!

[Scuba]

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Originally Posted by MichaelB Those are two excellent reasons, and I'm sure represent the vast majority (>90%) of HMO choices.

A lot of people in CA seem pretty happy with Kaiser. Many employers here offer only Kaiser, no PPO option, so people get used to it. Most of the plans in our market are either Kaiser or BCBS. Anthem pulled out of ACA plans in this market this year. We were able to keep our pre-ACA “grandfathered” Anthem PPO plan, at least so far. DH and I have always had access to a PPO so we hope to keep this coverage indefinitely.