Poll:What type of insurance did you get for early retirement (HMO vs PPO)?

[cyber888]

I'm looking at ACA plans since I plan to retire by the end of this year or maybe early next year.

Looking at Healthcare.gov, there's big savings on HMOs without Out-of-Network coverage, but PPO has the advantage of Out-of-Network coverage.
My work insurance is currently PPO.

Now, they've got a new law effective Jan. 2022 that there are no more surprise expenses from Out-of-Network coverage, does that mean HMO will have an advantage now?

Well, I'd like to do this as a poll (HMO vs PPO vs Other types) but you're welcome to comment on your experience on the limitations of HMOs.

Does the PPO Out of Network coverage includes if you get sick traveling in Europe or Asia ? Or do you buy separate healthcare insurance when you travel ?

 

[MissMolly]

PPO, since that is what is offered with my retiree benefits. So far, no complaints. Having spinal surgery in 2 weeks. Husband rotator cuff surgery 2years ago, I had carpal tunnel revision surgery last year. Insurance paid exactly as outlined in the policy coverage. No complaints. Offers nationwide coverage and emergency coverage if overseas, but we don't travel overseas.

 

[aja8888]

Medicare here.....M + supplemental.

 

[savory]

We were PPO for years until our recent move. We are HMO with Kaiser now, about 5 years, and we really like it. The coordination of care, one stop visit for everything, a concern (at least it feels that way) for preventative care. We are covered when out of their coverage domestically and internationally.

We will be moving and need to choose again, like the OP. I am interested in opinions from those who have used an HMO and prefer it and those who have had a bad experience. I am leaning to an HMO but perhaps Kaiser's just good at it.

It would be appreciated that when you address the OPs post that you add your thoughts about the related question I am asking here. If Mods feel this is a hijacking of the OPs post (or the OP does), let me know and I will take it down.

 

[stepford]

DW has an HMO (Kaiser) while I have BC/BS PPO. Initially I much preferred my PPO for my ability to just schedule an appointment with a specialist without having to go through a referral process. As the years have gone by, though, I'm finding most in-network doctors now have such a long wait time for appointments that my wife actually sometimes gets to see specialists faster than I do. Some of this may be the effects of COVID on the overall healthcare system, but as this point DW's Kaiser plan is looking pretty good to me.

 

[Alan]

When we retired we stuck with my ex-employers PPO even though the HMO offerings from them were much cheaper. Few issues when traveling, just needed to be sure and stay in network. This was Blue Cross/Blue Shield and before every big trip I would go online and check out and make a note of the in-network facilities of where we would be staying, and that included countries abroad such as Europe, Canada and Australia. The only country I couldn’t be sure of was Vanuatu and since we were there only a week I took out specific travel insurance.

 

[PaunchyPirate]

I've had both an HMO and PPO in my 3 years of retirement. I prefer the PPO and am glad to have it back this year. A PPO has not always been available to me in my location.

The recent surprise billing law changes do not really help you out much in the day-to-day operation of your HMO. If you're in a location where there are no doctors/hospitals who are part of your HMO, then you will likely pay full price for any non-emergency care you may want/need. There is no surprise billing aspect to what you would be seeking out.

All ACA plans (PPO, HMO, EPO, etc.) are required to cover true emergency situations anywhere in the USA. It's when the emergency is over or when it is not a true emergency that you need to understand what you will have to pay for.

 

[SecretlyFI]

What about an “EPO”? I am also researching plans on the exchange and it seemed like most in my state were either HMO or EPO. Anyone know if EPO’s are more like HMO’s or PPO’? I also am concerned with nationwide and out of network coverage.

 

[PaunchyPirate]

What about an “EPO”? I am also researching plans on the exchange and it seemed like most in my state were either HMO or EPO. Anyone know if EPO’s are more like HMO’s or PPO’? I also am concerned with nationwide and out of network coverage.

My location's local BC/BS company offers EPOs. As near as I can tell, they are glorified HMOs. There is a defined network that you must use. However, you don't need to get your PCP involved in referrals to see specialists. As near as I could tell, that is the only difference between an EPO and an HMO.

 

[Aerides]

I have an EPO, which in my state means I have an in-network price and deductible, and a separate (double) out of network deductible. So I of course stay in network. But I don't have to go to my primary for a referral to see a specialist or anything, which I like and use a lot.

The other thing is of course, you can change every year. If an HMO works for you, great. If it doesn't, you can switch the next year. And so on.

 

[cyber888]

Medicare here.....M + supplemental.

Hi ... did you get Medicare at full retirement age of 65 ? or did you retire early like 50 - 59 and get Medicare due to your specific condition ? Thanks.

 

[MichaelB]

Now, they've got a new law effective Jan. 2022 that there are no more surprise expenses from Out-of-Network coverage, does that mean HMO will have an advantage now?

The new regulation means no more surprise expenses from out of network in situations involving emergency room and subsequent care. For regular continuing health care, you are still liable for out of network charges.

 

[pacergal]

When first retired, we kept the PPO from my retiree insurance, they also offered Kaiser. We tried Kaiser the last 2 years before going on medicare as I just wanted to explore it.
We have been so happy with it, that we signed up for Kaiser Medicare Advantage Plus.
No problems at all with getting referrals, love the ease of one stop shopping, and the strong emphasis on preventative care, along with the ease of electronic medical records, video visits, etc.
Being in the medical field for over 40 years, I feel confident in the choice.

Recently referred for PT, Kaiser PT couldn't get me in for 4 weeks, so they sent me to an outside provider, who got me in quickly. So out of network isn't necessarily not available.

 

[Gumby]

I have retiree health insurance from my last employer. We chose the POS option, because that's what we had when we were employed. The POE plan would be cheaper, but more restrictive. As we become eligible for Medicare, we will switch to a Medicare advantage PPO plan paid for by my last employer.

 

[Splash]

ACA policies where I live are either HMOs or EPOs. Unfortunately, there are no PPO policies offered. Our policy is an EPO which is very similar to an HMO.

 

[rodi]

Your reasons (cheaper for HMO) are not necessarily true... since there are HDHP/HSA plans that are PPO that might be cheaper than an HMO without the high deductible.

I stayed with the HMO I have been on for over half my life. Kaiser Permanente. But when I retired and exhausted cobra - I switched to a HDHP version of Kaiser. I like my doctor, like their urgent care system. Any health insurance choice comes down to your primary care doctor... If you have a good one, stay with the plan that lets you keep that doc.

That said - when I go on Medicare in 5 years I'll probably switch to a G+ plan. Just to have all the options grandfathered in from when I sign up. My parents were on Kaiser Advantage, as is my step mom (who has the same primary as me.) But I think I'll be ready to switch at that point.

 

[cyber888]

Agree. In some areas, it could be true, but I'm just generalizing that HMOs are usually cheaper than PPO in most areas - maybe 90% or even 85% of the time it is more expensive.

Your reasons (cheaper for HMO) are not necessarily true... since there are HDHP/HSA plans that are PPO that might be cheaper than an HMO without the high deductible.

I stayed with the HMO I have been on for over half my life. Kaiser Permanente. But when I retired and exhausted cobra - I switched to a HDHP version of Kaiser. I like my doctor, like their urgent care system. Any health insurance choice comes down to your primary care doctor... If you have a good one, stay with the plan that lets you keep that doc.

That said - when I go on Medicare in 5 years I'll probably switch to a G+ plan. Just to have all the options grandfathered in from when I sign up. My parents were on Kaiser Advantage, as is my step mom (who has the same primary as me.) But I think I'll be ready to switch at that point.