HMO vs PPO ?

[MBSC]

ACA PPO plans are going away for us. HMO only, no HSA compatible plans either. On or off exchange doesn't matter.

BCBSTX has three HSA eligible HMO plans for 2017. They are available in all counties. They are listed as "Bronze HMO 006", "Bronze HMO Plus 104", and "Silver 103". The Silver plan may not be HSA eligible if you qualify for Cost Sharing Reductions (CSR) that lower the deductible below the HSA minimum.

 

[bingybear]

The two plans I was considering for 2017 are called HMOs, but neither require referrals from a PCP. I don't think you have to define a PCP as I recall. I thought this was odd for an HMO, but it clearly stated that you don't need a referral to see a specialist.
It does clearly state that you have to be in network for the HMO or no coverage (Emergency Room care for medically necessary care was the one exception to being in network).

 

[Murf2]

Sorry for the dumb question but a "referral from a PCP". PCP = primary care provider?
So that would mean I have to get my regular doctor to refer me to the specialist? In my case, my doctor is pretty easy to get to do that.

Thanks
Murf

 

[2017ish]

Sorry for the dumb question but a "referral from a PCP". PCP = primary care provider?
So that would mean I have to get my regular doctor to refer me to the specialist? ...

Yep. Only area worse for acronyms than personal finance is healthcare!

PCP typically is internist/family practice, some plans will [historically?] allow OBGYN, nurse practitioners becoming more common PCP too.

 

[MichaelB]

Sorry for the dumb question but a "referral from a PCP". PCP = primary care provider?
So that would mean I have to get my regular doctor to refer me to the specialist? In my case, my doctor is pretty easy to get to do that.

Thanks
Murf

That's it, as long as your doctor is in the HMO network. As Henry Higgins would say, "By George, you've got it!".

 

[audreyh1]

BCBSTX has three HSA eligible HMO plans for 2017. They are available in all counties. They are listed as "Bronze HMO 006", "Bronze HMO Plus 104", and "Silver 103". The Silver plan may not be HSA eligible if you qualify for Cost Sharing Reductions (CSR) that lower the deductible below the HSA minimum.

OK- great, thanks much!

For some reason when I looked at their choices last year for 2016 I thought none of them were HSA compatible as they all had low copays.

I thought I had looked at the Bronze HMO Plus.

Glad to know I do have HSA options for 2017!

 

[Teacher Terry]

We have been in a HMO for years and it is good. No referrals needed. If you are out of town and no network docs you can still use your insurance and be covered. Actually when people get a serious disease they switch from the PPO to the HMO.

 

[GTFan]

ACA PPO plans are going away for us. HMO only, no HSA compatible plans either.

On or off exchange doesn't matter.

Same here and we're down to two choices now for 2017 - Kaiser and BCBS. Humana, Coventry, Cigna and Harken have left the exchange. Think we had those 6 to pick from this year.

Our subsidy is projected to go from $900 to $1100 a month with same income as this year (just under 150% FPL for two). Wow.

 

[fh2000]

Anthem Blue Cross may leave marketplace in 2018:

Insurer Anthem suggests it may leave Obamacare by 2018 - UPI.com

We may have to go with Kaiser HMO plan by then.

 

[SpinDr]

I've been with an HMO for years here in SoCal and have had no issues getting excellent quality treatment. Have had some pretty big surgeries and the Dr's available were considered top quality in their fields.

Biggest downside affecting me is that HSA accounts cannot be created/funded. I would really like that triple tax benefit for that option

A small side note. It has seemed that my company really seems to push the PPO option when communicating benefits and the HMO seems to get short shrift. Being a bit cynical I've wondered if the PPO favors the company financially?

 

[MooreBonds]

A small side note. It has seemed that my company really seems to push the PPO option when communicating benefits and the HMO seems to get short shrift. Being a bit cynical I've wondered if the PPO favors the company financially?

Perhaps the executives prefer the PPO, and want to ensure that a large % of employees choose that so it has a better chance of continuing as a good option? Also, have you done a complete comparison of all of the various benefits of the HMO vs PPO, to make sure they are somewhat comparable and not leaving something out?

 

[haha]

Anthem Blue Cross may leave marketplace in 2018:

Insurer Anthem suggests it may leave Obamacare by 2018 - UPI.com

We may have to go with Kaiser HMO plan by then.

My girlfriend just had surgery at Group Health Washington, an HMO Co-op. I was her escort, chauffeur, etc. I was very impressed with how thorough they are before and after surgery. She is almost recovered now and it appears to me that everything is fine.

My cousin had a very serious neurological issue needing surgery about t year ago. They live in Manhattan Beach, and he got care at the big Kaiser Hospital in Hollywood. His care was excellent, and well organized, and he is fine now.

I am kind of a control freak so Classic Medicare appeals to me, but if things change I will be OK with joining Group Health. When I lived in LA I was a Kaiser member.

Ha

 

[SpinDr]

Perhaps the executives prefer the PPO, and want to ensure that a large % of employees choose that so it has a better chance of continuing as a good option? Also, have you done a complete comparison of all of the various benefits of the HMO vs PPO, to make sure they are somewhat comparable and not leaving something out?

Very well could be, but each year I've looked at the options it's worked out best financially for us to use the HMO option. When I first had the choice my concern was Dr availability and secondarily the HSA option. No issues with Dr availability since I've been in the plan for approx 5 years. So far the the HSA availability is the main item that I miss using the HMO.