Do the PPO and HMO options have significantly different lists of providers that may come into play if you get referred to some other specialist that you are not already a patient of, or if you need to stay in a hospital?
As far as I can see, the provider lists are the same for both the PPO and the HMO
Both are BCBS bronze plans, the only difference is the designation and $250 a month, I can compare the plans on healthcare dot gov. The deductible, all take my doctors and my medication. Although I use a different place thatās cheaper for my prescriptions.
Iām in a rural area so the list of providers isnāt going to be as big as a large urban area
Thanks, these are great questions to ask at the meeting I have on Monday.
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Ask how long it takes to get an appointment with a HMO referral. Sometimes PPO patients go to the head of the line or the specialists limit the number of HMO patient theyāll see during a given month.
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We had an HMO through Hās job for a few years. It wasnāt awful, just a bit annoying in terms of having to get prior authorization - it went relatively quickly, though. If all of your doctors are on the plan, it may be fine to give it a try. As long as you have the option of getting care in the ābig cityā if you suddenly have a health concern ā¦
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One other thing I noticed about the plan I have at work is that the total (employer + employee) cost is much less than what an ACA plan would cost me from the same insurance company and same provider network. This is likely because the workplace employee demographics skew significantly younger than my age.
The total cost of the employer plan can become directly relevant if COBRA coverage comes into play (e.g. if retiring before Medicare age).
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WP had this article this morning on increasing premiums and how individuals across the country are impacted. https://wapo.st/43Q4Iag
I went on the Virginia Marketplace earlier this week to see if I could possibly manage to find another plan. In my geographic area I have the choice of two insurers. One is offered by the hospital system. One would think my PCP, who works at said hospital system, would be an in-network provider. He is not. What? All the plans, including my current one, are HMOs. The other insurer is Anthem. Thatās it. It should not be like this.
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Iām on Medicare Advantage. Premiums are only what medicare A & B are (about $185?) and Iām sure will go up a little, but what changed was my OOP max from $4000 to $5600, dental changed from $2250 (full coverage until you hit that) to $3000 but only at 50%, prescriptions were about $800 max OOP (they had a weird way to calculate it so hit the $2000 medicare max without actually hitting it) to now 16% of tier 3 drugs and I estimate that will cost me the full $2100 max allowed by medicare. They also cut down on eye and hearing aid coverage. Oh, and co-pays went from $20 to $40 per visit; that one will kill me.
Yes, the premiums didnāt go up (much) but Iāll be paying a lot more OOP. I could afford PT at $20 copay but not at $40. I already told my doctor Iām not taking two of my drugs that are tier 3 and she needed to find something else. Most of it is the pure cost, but some of it is these drugs are advertised on TV and I donāt want to pay for the advertising. They may be the best drugs for me, but I live on a budget.
I panicked yesterday when I read on the insurerās webpage that my YMCA membership was changing from Renew Active to Premium. Sounded expensive but it will still be no extra charge to me. THAT is my favorite benefit. The OTC benefit goes from $65/quarter to $50.
Itās all in the small print.
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Thanks for the link. Lot of info and stories.
For our CC retiree gang, this story was scaryā¦
*Douglas McCombs, 63; Kiki Yablon, 56 - Chicago
Monthly payments rising from $1,269 to $2,746
*
I am gonna try hard to NOT lament my sub-$1000 (barely) monthly cost for self, especially since I have a partial employer subsidy. Iām really worried for the many folks not as fortunate.
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My Medicare supplement went up 10% this year. Part of the increase was attributed to a change in the āareaā covered by the plan. More people were added from outlying areas. These additional areas are rural. Iām not drawing any conclusions from that, just stating a fact.
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This John Oliver deep dive into Medicare Advantage is informative and entertaining at the same time.
ETA: There is some R rated comedy, especially at the end you may want to skip.
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The town I live in is an āindependent cityā within the county. When I am searching for plans, I have to indicate if I am in the city or the county. If I had to guess, the bulk of individuals within the City are covered by the state health plan (university town) or have terrible or no insurance. We have at least two large employers in the County, also offering decent benefits. A lot of agriculture and I would guess quite a few choosing not to have coverage or opting to follow a mutual aid model.
My supplement went up 15%.
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I hate to be the police but we have a 64 and looking into Medicare.
I was hoping this would be for those not on Medicare yet and are looking at ACA plans. Employer plans also but since so many of us are in sticker shock about our ACA plans, I was hoping we could discuss that here.
I for one know about both. Medicare beats my ACA Plan by a lot. Coverage and cost, thereās no comparison
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Not your fault but since I once subscribed to the Washington Post, I canāt read a gifted article
Got to love it
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This is almost exactly me. To keep the same ins. company and same networks, my plan will go from $1313 (subsidized) to $2590 (unsubsidized) the deductible goes from $0 to $3800 each, doctor copays go from $22 to $70, drug copays approximately triple, etc.
So, double the price with substantially worse coverage.
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Iām a former WAPO subscriber and I can read the article gift linked above. 
That page has a link to the following which shows changes by state. Of course, some local regions in each state may have changes that vary from the state average.
There is also a table of average monthly costs:
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Maybe Iām doing something wrong. I click the link and it asks for my email address. After I enter, I get a notice that Iām a past subscriber and I need to resubscribe. Iām not always the best with technology
The good news is that I could read the article through my Apple News feed, where I have a subscription
Me tooā¦but Iām not a Wapo subscriber.
Well guys, I am sorry. I just wonāt offer any additional articles.