Obamacare Plans - Decisions, Decisions

[Ian S]

Since my BCBS of Arizona PPO plan was cancelled for 2016, I have to get another exchange plan. This will be a short term policy since I will be going on Medicare August 1, 2016. It pretty much comes down to another BCBS plan (HMO) or a United Healthcare PPO. Neither plan has all of my docs but the BCBS plan at least has my current PCP. Deductibles are about the same and so is maximum OOP. Drug coverage is also comparable. However, the BCBS plan is nearly $50/mo more expensive so I was starting to lean toward the UHC PPO which has the two hospitals closest to me in network and a bunch of urgent care clinics. But, from online reviews, there seem to be a lot of horror stories about billing and pre-authorization issues with UHC. In contrast, my experience with BCBS of Arizona has been fine - I don't recall any pre-authorization issues ever although that may just be that anything that required such was cut and dried in my case.

The other consideration is that this policy will only be for 7 months and I'm in good enough health that I'm unlikely to need to go to the doctor in that timeframe. I am seeing my gastroenterologist early next month but shouldn't need to see him again before I go on Medicare. Same with my ophthalmologist. I guess I could get a new PCP if I want a free physical but I'd likely return to my existing PCP once on Medicare assuming he doesn't retire which is a distinct possibility.

I'd really like to hear about some folks' experiences - good and bad - with UHC especially those related to an individual plan.

 

[MichaelB]

We had UHC for a few years prior to the ACA. Their online systems are better than others I have used, I don't think they are any better or worse than BCBS, and there is an abundance of negative feedback for just about every health insurer in the US. Now all ACA compliant policies have similar coverage, so I would look at the two areas where they will differ - network and the formulary.

 

[Live And Learn]

If it were me I'd make the decision based on HMO vs PPO. If you have a chronic medical problem that might need quick treatment by a specialist (eg: macular degeneration) you might want to opt for the PPO.

 

[Ian S]

If it were me I'd make the decision based on HMO vs PPO. If you have a chronic medical problem that might need quick treatment by a specialist (eg: macular degeneration) you might want to opt for the PPO.

That's a good point although the BCBS HMO allows you to see a specialist without a referral. Of course that specialist has to be in-network for them to cover anything. It really is more like a limited network PPO except that it won't pay anything for out of network.