Questions About Arizona ACA

[badatmath]

Is there really only 1 PPO plan for Maricopa county or am I reading this wrong?

Does anyone have an ACA plan they like with good access to providers?

I just do not see an HMO as being a good choice but then I admit I have not had one.

I will need to look at the the website more properly on a day I am not so busy and tired.

 

[badatmath]

I guess those were the wrong questions but I will need to do more looking and check reddit etc.

 

[DayDreaming]

I'm not from AZ but here's what I found. - if this link works, it shows 5 PPO plans for zip code 85138.

If that link doesn't work, or if your zip code is different, try this:
Got to https://www.healthsherpa.com/
enter your zip code and other relevant information.
When it show you plans, it defaults to showing you the one most affordable plan, but just click "All plans" in the top menu bar to see all plans. You can select PPO in the left column to see only those networks.

 

[Alex The Great]

I'm also not from AZ, but in my area (SF Bay area in CA) there is also just one PPO provider in marketplace: Blue Shield of CA. Do you have different expectations?

 

[badatmath]

I'm not from AZ but here's what I found. - if this link works, it shows 5 PPO plans for zip code 85138.

If that link doesn't work, or if your zip code is different, try this:
Got to https://www.healthsherpa.com/
enter your zip code and other relevant information.
When it show you plans, it defaults to showing you the one most affordable plan, but just click "All plans" in the top menu bar to see all plans. You can select PPO in the left column to see only those networks.

Thank you. 1 PPO that I cannot afford and does not cover my doctors.

I'm also not from AZ, but in my area (SF Bay area in CA) there is also just one PPO provider in marketplace: Blue Shield of CA. Do you have different expectations?

See above. Plus a lot of HMOs are companies I have never heard of. I had to guess at my income due to layoff. No severance but I will have some pto payout.

Anyone know a quick way to compare the companies themselves? Like customer service, stability, etc.

99% sure I will be able to turn down an outsourced job offer and qualify for retiree medical but I thought it would be smart to look what was out there.

 

[PaunchyPirate]

Welcome to the wonderful world of buying your own medical insurance in the USA. The quality of insurance plans varies widely across the nation. As you have found out, it is even specific to your own zip code.

I am not aware of any quick way to compare insurance companies. If possible, I would stick with one of the older, more established names in the business -- Blue Cross/Blue Shield, etc. There have been many new companies that have popped up in recent years and some haven't even been around long enough to have a "track record".

Be certain to also consider COBRA. If you lose your job, you should be entitled to buy your current plan for 18 months (or more, in some states) from your current employer (or their COBRA administrator). The cost will likely be significantly higher than you pay the employer for the coverage, but it might be better coverage than you can find on the ACA exchange. Of course, if you qualify for ACA subsidies, you can't get them if you buy the COBRA option.

 

[cathy63]

Yes definitely consider staying on COBRA until at least the end of this year if you don't qualify for the retiree health coverage. You will have to pay 102% of the full premium since the employer won't subsidize it any more, but especially if you work with a lot of younger people, that premium could be lower than an ACA plan and have better coverage.

If you switch plans in the middle of the year your deductible and max OOP calculations start over, so depending on how often you use your health insurance it may be best to avoid that and time a switch for Jan 1.

 

[badatmath]

Yes definitely consider staying on COBRA until at least the end of this year if you don't qualify for the retiree health coverage. You will have to pay 102% of the full premium since the employer won't subsidize it any more, but especially if you work with a lot of younger people, that premium could be lower than an ACA plan and have better coverage.

If you switch plans in the middle of the year your deductible and max OOP calculations start over, so depending on how often you use your health insurance it may be best to avoid that and time a switch for Jan 1.

Another very good point that I would not have thought of! And I expect to use more than normal this year.

 

[Choosehappy]

Not a PPO, but we chose an OSCAR plan for 2022. We had a Cigna PPO through work and definitely missed the ability to go anywhere. Oscar worked out OK for us because we chose a plan that allowed us to keep our current specialists.
Downside is our primary dr of 30 years isn’t on the plan so we’ll need to pay out of pocket for visits.
Upside is our prescriptions and labs have been much lower than Cigna and we also don’t need referrals (provided they’re in-network). So it’s not quite a PPO, but better than paying $2400/mo for BCBS (which is the only option in AZ for 2023) or going with a traditional HMO that requires referrals IMHO.

 

[badatmath]

Oscar worked out OK for us because we chose a plan that allowed us to keep our current specialists.

Can you expand on this? I mean how many "specialists" can I keep? If I fail to get the retiree medical, and go on cobra then I will have to decide this all over again next year (unless I get a job).

 

[PaunchyPirate]

Can you expand on this? I mean how many "specialists" can I keep? If I fail to get the retiree medical, and go on cobra then I will have to decide this all over again next year (unless I get a job).

If you go the ACA route, you will need to re-evaluate this EVERY year until you go on Medicare. Things can (and often do) change every year -- new insurance companies, new insurance plans, modified insurance plans, changes to what plans consider in-network and out-of-network, changes to prescription co-pays and drugs that are covered, etc. It is a yearly time suck that officially begins on November 1st every year. I start my research in October as information for the coming year slowly is revealed by the various companies.

I'm now in my 5th year of ACA and I've used plans from 2 insurance companies. I'm quite happy with my current PPO from BC/BS (I'm in western PA). But I know it all can change next year. One year at a time is the best we can do.

 

[badatmath]

If you go the ACA route, you will need to re-evaluate this EVERY year until you go on Medicare.

Frankly sounds dreadful to someone who has had the same insurance with very minor tweaks for more than 30 years.

I thought the Medicare Part D would be bad enough.

 

[Choosehappy]

Can you expand on this? I mean how many "specialists" can I keep? If I fail to get the retiree medical, and go on cobra then I will have to decide this all over again next year (unless I get a job).

Like Paunchy Pirate said, it depends on the plan and it is a Big time investment. Just within Oscar, we had to change plans for 2023 because they decided not to continue with our plan. Each year I look at all the different providers and identify those that have our current specialists. Then I take those and put all of the coverages and costs associated into a spread sheet. From their DH and I decide what works best for us.
It was definitely a lot easier when we were working for corporate America because there were A LOT less medical plan options so you didn’t have to think too much about it and not much changed from year to year (for us anyway).
One thing nice about the ACA is the tax credits if you can keep your income low (for us that’s below $100k). Of course that could and probably will go away in the future.
I’d love to have BCBS, but not at a premium that’s over $1000 more a month for just the two of us.
Best thing for you to do now is to create a Healthcare.gov account and play around with it. It should give you a feel for your options without having to commit.

 

[PaunchyPirate]

Frankly sounds dreadful to someone who has had the same insurance with very minor tweaks for more than 30 years.

I thought the Medicare Part D would be bad enough.

I should add, it’s not always bad. For 2023, I ended up staying with the same insurer and in the same plan with exactly the same coverage. But I still did the research to determine if something else was a better option for me. It just so happened it wasn’t. This year was relatively easy for me. Fingers crossed it stays this way for 5 years when I can get Medicare.

 

[zinger1457]

I had been on ACA in AZ since it started up until the end of 2022 when I moved to Medicare. My priority was to get the lowest price HSA compliant plan I could get and to max out the subsidy, so always has a bronze HMO HDHP. I was able to keep my PCP but not sure it would have mattered much to me, didn't have any medical issues to deal with so had no lists of doctors I needed or wanted access to. Similar to what you're seeing, the PPO plans in my area were very limited, and the most expensive. And as was stated, a plan offered this year won't necessarily be available in following years, insurance companies and plans can change from year to year. Hopefully not long before you get on Medicare, until then be prepared for a roller coaster ride.