I’m transitioning from COBRA coverage, where I have a PPO, to health insurance from the Marketplace. I’ve found an HMO which is affordable, has all of my doctors in-network, and covers all of my medications. The Summary Plan Description makes it clear that out of network providers are not covered under the plan.
My son goes to college out of state. While he gets his routine care when he comes home, and it looks like emergency care is covered, with a co-pay, even out of network. For those of you in HMOs, what do you do about coverage for your out-of-state students? What about when you travel?
I will call the Plan tomorrow to ask those questions, but I’m wondering whether anyone here has some thoughts on the matter. Thanks.
It is best you call your insurance. Your son most likely will not be covered while he is in school through your HMO. His school may mandate he takes his school insurance.
We’ve usually ended up with a BCBS plan with the national network included when kids are OOS at school. Then they can get care at home and at school that is “in network”. However, this past couple of years, there has been a trend for the Blues to drop their national network from some of their individual plans, so then that is not a solution. In my state, although there are two BCBS providers, as of this coming year, neither offers an individual plan with the national network.
Not all colleges offer a school plan, but that is probably what we would have done.
Stuff happens when they are at school. One of mine broke her arm. The original emergency visit for X-ray and diagnosis would have been covered, but I doubt the follow up visits with the ortho dr would have been considered emergency care.
My son’s school doesn’t offer a health plan, so that isn’t an option. I can cover him under the HMO in which I plan to enroll, but it does not appear that there are any in network providers in the area where his school is located. Inparent, your experience is what I suspect is what would happen to my son. Or, if he has a fever and needs to see a doctor, the visit and any tests, follow up, etc., wouldn’t be a covered expense.
From my experience, HMOs often involve a larger co-payment then a PPO.
When my son went to college out of state, I got his insurance they his U. My PPO was in-state for me, so would have been a hassle for him. When he came home from grad school, he was so ill I took him to the ER. Because his insurance was BC/MA, they charged us $100. That was a bargain.
As you can see, it really depends on the plan. We had an HMO in CA and they had an option for D to have coverage through their NY HMO where one of my D’s was in school.
We’ve also had an HMO where emergency coverage was the only option for out of state. That, along with student health services. If that’s the case, you’d have to decide whether that was adequate coverage.
We’ve also had PPO coverage off and on and, unlike bookworm, our out of pocket was always more with the PPO. Again, things vary widely.