ACA EPO question

always_learning

Recycles dryer sheets
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I searched and read several threads but didn't see the answer so if it's out there, someone please point me in that direction.

We're down to either an EPO or a PPO and can't decide. The EPO looks "too good to be true" as it's significantly less expensive than the PPO.

We are looking at Florida Blue Bronze plans on the Marketplace, if that makes a difference.

The plan documents are identical for coverage as far as I can tell and the only thing I can find that the EPO needs an Exclusive Provider for is home health/lab stuff which isn't a problem for us.

Our doctors show up as "in network", as do the hospital systems/urgent cares around us. Is that enough due diligence or is there another tier of providers secreted away somewhere that might catch us off guard?

This is the first I've heard of EPO plans so I'm afraid I'm missing something important.
 
I am just ending being on the Florida Blue EPO plan, but it is a silver plan. My plan effectively was the same as a PPO plan but only in state. That is what I was explained. Never had it tested as didn't see any out of state doctors.
 
That's what I'm seeing, so thanks for your reply. It's quite unnerving as the difference between the cost of the two plans is more than 40% so it feels like there is a big "gotcha" somewhere.
 
I had the plan for 7 years and did not experience any gotchas. lol
However my premiums did go from 67 monthly to 286 monthly in the 7 years while mainly using around the same MAGI each year. Still 286 monthly is still a bargain.
 
FloridaBlue offers 3 plan categories. BlueCare and MyBlue are HMOs. Blue Select is a PPO with a more limited provider network. BlueOptions uses the BCBS “BlueCard” provider network, which is nationwide.

The biggest difference between BlueSelect and BlueOptions is the local provider network for BlueOptions is much larger.

Both plans are ACA compliant so there is no meaningful difference in coverage. When I used those plans, the EPO parts were pediatric dental and vision.
 
Our doctors show up as "in network", as do the hospital systems/urgent cares around us. Is that enough due diligence or is there another tier of providers secreted away somewhere that might catch us off guard?
Both BlueSelect EPO/PPO and BlueOptions PPO use the BlueCard national provider network for coverage outside Florida. BlueSelect EPO/PPO plans use a smaller in-state network. The Mayo Clinic in JAX is not in the BlueSelect network, but the Minnesota location is in BlueCard. As you said, it's only an EPO for certain services like lab, home health, DME, dental and vision.

BlueSelect EPO offers affordable plans with thousands of doctors and hospitals at less cost. You'll have access to a select network of providers and hospitals in Florida, plus out-of-state coverage, so you're protected wherever you go.
BlueSelect plans at a glance: In-network health coverage available in all 50 states including facilities that specialize in complex medical conditions.


BlueSelect Plan Brochure

BlueOptions PPO
The largest provider network in Florida, plus access to doctors and hospitals out-of-state. With over 90% of providers and hospitals in Florida, and coverage that extends across the states and abroad, you're protected wherever life takes you.
BlueOptions plans at a glance: In-network health coverage available in all 50 states including facilities that specialize in complex medical conditions.


 
I had the plan for 7 years and did not experience any gotchas. lol
However my premiums did go from 67 monthly to 286 monthly in the 7 years while mainly using around the same MAGI each year. Still 286 monthly is still a bargain.
That's reassuring to hear.

FloridaBlue offers 3 plan categories. BlueCare and MyBlue are HMOs. Blue Select is a PPO with a more limited provider network. BlueOptions uses the BCBS “BlueCard” provider network, which is nationwide.

The biggest difference between BlueSelect and BlueOptions is the local provider network for BlueOptions is much larger.

Both plans are ACA compliant so there is no meaningful difference in coverage. When I used those plans, the EPO parts were pediatric dental and vision.
This is helpful, thanks! If it's laid out like this on their site, I surely missed it. I have saved & printed so much stuff in trying to learn about all of this, it's crazy.


Both BlueSelect EPO/PPO and BlueOptions PPO use the BlueCard national provider network for coverage outside Florida. BlueSelect EPO/PPO plans use a smaller in-state network. The Mayo Clinic in JAX is not in the BlueSelect network, but the Minnesota location is in BlueCard. As you said, it's only an EPO for certain services like lab, home health, DME, dental and vision.

BlueSelect EPO offers affordable plans with thousands of doctors and hospitals at less cost. You'll have access to a select network of providers and hospitals in Florida, plus out-of-state coverage, so you're protected wherever you go.
BlueSelect plans at a glance: In-network health coverage available in all 50 states including facilities that specialize in complex medical conditions.


BlueSelect Plan Brochure

BlueOptions PPO
The largest provider network in Florida, plus access to doctors and hospitals out-of-state. With over 90% of providers and hospitals in Florida, and coverage that extends across the states and abroad, you're protected wherever life takes you.
BlueOptions plans at a glance: In-network health coverage available in all 50 states including facilities that specialize in complex medical conditions.


I did download the EPO brochure the other day but it didn't really help us in figuring out what the differences were between the two plans and why the EPO was so much less than the PPO. The 150+ page summary of benefits for each was also less than helpful. This insurance stuff is for the birds.

I definitely didn't know that about Mayo. How strange.

Thanks everyone!
 
Probably too late to affect anything but it would definitely be worthwhile for you to contact your local Florida Blue office to ask about the differences between various Florida Blue networks. Like you, we were very confused by all their terminology on networks. We ended up scheduling a meeting with them to better understand everything and found it to be useful. Once you select a plan, they will even log into the marketplace and sign you up while you wait - much easier than navigating that web site on your own.

We were on a BlueSelect bronze plan this year, but changed to a BlueSelect silver plan for 2025 to take advantage of CSR's thanks to abnormally low income next year. I didn't have an issue with the doctor selection with BlueSelect, never had a problem finding doctors or specialists that took the plan.
 
I'll be testing Anthem Blue Cross of CA EPO on ACA next year. Like others, I can see all my doctors and nearby hospitals in the network, except Stanford but it was not in Blue Shield PPO plan either. The premium cost dropped from $435/mo (in fact it is >$600/mo for 2025) to $106/mo.
 

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