Health Insurance: Public-exchange ACA plans on HealthCare.gov - Do they have advantages over private plans?

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teelainen
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Health Insurance: Public-exchange ACA plans on HealthCare.gov - Do they have advantages over private plans?

Post by teelainen » Fri Nov 08, 2019 11:57 am

We are self-employed and shopping for a health insurance plan for 2020. We have been considering the public exchange ACA plans on HealthCare.gov

I just looked at some of the plans and although the plans are all HMO, the coverage still seems pretty decent.

For example, with the Blue Cross Blue Shield HMO plan that is being sold on HealthCare.gov here in my state, most of the doctors and hospitals that we use (about 80% of them) are in-network.

Why does everyone think the public exchange ACA plans on HealthCare.gov are so bad? I have been comparing them to some private PPO health insurance plans from brand name insurance companies and believe it or not, the private PPO plans from brand name insurance companies are actually cheaper.

So if the Blue Cross Blue Shield HMO plan from HealthCare.gov is more expensive than a private PPO plan from a brand name insurance company, this must mean that the Blue Cross Blue Shield HMO plan from HealthCare.gov is better right?

However, my question is: How can a public-exchange HMO plan be better than a private PPO plan from a brand name insurance company? Is there something bad about private PPO plans from brand name insurance companies?

SimonJester
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Re: Health Insurance: Public-exchange ACA plans on HealthCare.gov - Do they have advantages over private plans?

Post by SimonJester » Fri Nov 08, 2019 12:20 pm

Need to compare apples to apples.

You need to know the Plan premium, Deductible, Co-Pays, Out of Pocket Max, and Co Insurance after the deductible.
Then you need to see which providers are in network for each plan.

The last part we cannot compare is the negotiated rates for various procedures between each plan.

An HMO tends to be more restrictive then a PPO or EPO in terms of providers you can goto.
"They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety." - Benjamin Franklin

SeekingAPlan
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Re: Health Insurance: Public-exchange ACA plans on HealthCare.gov - Do they have advantages over private plans?

Post by SeekingAPlan » Fri Nov 08, 2019 12:27 pm

Where I live the ACA plans all have very narrow and very local networks. There is no out of network coverage other than for a life threatening emergency. If I take a day trip to the lake or to visit family and I am not literally dying I have no coverage at all. I am 4 years from Medicare and would love to be able to purchase a PPO with a decent network. The only ACA PPO available has such a narrow network I cannot find any providers in my area that accept it.

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Phineas J. Whoopee
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Re: Health Insurance: Public-exchange ACA plans on HealthCare.gov - Do they have advantages over private plans?

Post by Phineas J. Whoopee » Fri Nov 08, 2019 6:18 pm

They are all private plans. None is a public plan. They are all offered by private insurers.
PJW

michaeljc70
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Re: Health Insurance: Public-exchange ACA plans on HealthCare.gov - Do they have advantages over private plans?

Post by michaeljc70 » Fri Nov 08, 2019 6:30 pm

SeekingAPlan wrote:
Fri Nov 08, 2019 12:27 pm
Where I live the ACA plans all have very narrow and very local networks. There is no out of network coverage other than for a life threatening emergency. If I take a day trip to the lake or to visit family and I am not literally dying I have no coverage at all. I am 4 years from Medicare and would love to be able to purchase a PPO with a decent network. The only ACA PPO available has such a narrow network I cannot find any providers in my area that accept it.
Same here. On most plans here they exclude the 5 best hospitals in my (large) city.

A few other differences that come to mind but won't matter if your income is too high is you cannot get a subsidy or CSRs (lower co-pays, deductibles, out of pocket maxes) on an off exchange plan.

When I look at a site like eHealthinsurance.com or the BCBS site they don't have anything that isn't on the exchange (except short term plans) for my state/city. And I am in a big state. I don't know why a company wouldn't just sell on the exchange so they can get people with subsidies. Are you looking at plans for businesses or individual policies?

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Artsdoctor
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Re: Health Insurance: Public-exchange ACA plans on HealthCare.gov - Do they have advantages over private plans?

Post by Artsdoctor » Fri Nov 08, 2019 7:23 pm

teelainen wrote:
Fri Nov 08, 2019 11:57 am
We are self-employed and shopping for a health insurance plan for 2020. We have been considering the public exchange ACA plans on HealthCare.gov.

I just looked at some of the plans and although the plans are all HMO, the coverage still seems pretty decent.

For example, with the Blue Cross Blue Shield HMO plan that is being sold on HealthCare.gov here in my state, most of the doctors and hospitals that we use (about 80% of them) are in-network.

Why does everyone think the public exchange ACA plans on HealthCare.gov are so bad? I have been comparing them to some private PPO health insurance plans from brand name insurance companies and believe it or not, the private PPO plans from brand name insurance companies are actually cheaper.

THE REASON WHY SOME PEOPLE COMPLAIN ABOUT PLANS ON THE EXCHANGE IS BECAUSE THE CHOICES CAN BE LIMITED, AND/OR THE PREMIUMS CAN BE VERY HIGH, AND/OR THE DEDUCTIBLES AND CO-PAYS CAN BE MUCH HIGHER THAN SMALL GROUP OR EMPLOYER PLANS. HOWEVER, IT REALLY DOES DEPEND ON THE STATE.

THE REASON WHY HMO PLANS CAN SOMETIMES BE MORE EXPENSIVE THAN THE PPO'S IS BECAUSE YOUR OUT-OF-POCKET EXPENSES FOR THE HMO PLAN CAN BE RELATIVELY LOW. SOME PPO PLANS HAVE VERY HIGH OUT-OF-POCKET EXPENSES MAXIMUMS WHICH MEANS THAT THE PREMIUM CAN BE COMPARATIVELY LOW.

So if the Blue Cross Blue Shield HMO plan from HealthCare.gov is more expensive than a private PPO plan from a brand name insurance company, this must mean that the Blue Cross Blue Shield HMO plan from HealthCare.gov is better right?

IT'S NOT A QUESTION OF BEING BETTER. IT DEPENDS ON WHAT YOU WANT AND NEED. SOME PEOPLE ARE VERY SATISFIED BEING IN AN HMO WITH THE RESTRICTIONS THAT GO WITH IT. OTHER PEOPLE PLACE A PREMIUM ON HAVING MORE CHOICE. GENERALLY, MORE CHOICE CAN MEAN MORE EXPENSE.

However, my question is: How can a public-exchange HMO plan be better than a private PPO plan from a brand name insurance company? Is there something bad about private PPO plans from brand name insurance companies?

I DON'T REALLY UNDERSTAND YOUR QUESTION HERE. I WOULDN'T USE THE TERM "BETTER" BUT RATHER, "DIFFERENT."

IF YOU'RE SHOPPING ON THE EXCHANGE, MAKE SURE YOU UNDERSTAND THE SUBSIDIES. WITH SUBSIDIES, SOME THE PLANS CAN BE RELATIVELY AFFORDABLE WHEN IT COMES TO PREMIUMS. WITHOUT SUBSIDIES, THEY'RE GOING TO BE VERY EXPENSIVE. BUT AGAIN, IT ALL DEPENDS ON YOUR STATE.

DetroitRick
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Re: Health Insurance: Public-exchange ACA plans on HealthCare.gov - Do they have advantages over private plans?

Post by DetroitRick » Fri Nov 08, 2019 8:25 pm

We've been on ACA since start of program, and it's been great for us. But everything is local and the devil is in the details. The breadth of choices we have where I live is much different than many other areas. Here it really works well, other places not so much. We have lots of choices, but not everyone does.

Our current ACA Blue Cross HMO is a bit better than my former employer's healthcare offerings (A Blue Cross PPO mainly). And (pre-subsidy and adjusted for inflation), it's roughly the same premium as my employer and I used to pay for my coverage (combined employer and employee costs that is). But that is just one small data point. This is not universally true and you just can't generalize.

Beside the good advice already posted about carefully evaluating all the details - possible premium tax credits, possible cost-sharing reductions (income-based reductions of out of pocket maxes and deductibles), copay structure, drug formularies and so on - pay special attention to exact network breadth. In my state, Blue Cross Blue Shield is the clear majority insurer (both ACA, non-ACA and employer-based). But they have many different networks with similar names. Make sure you give that a close look. For example, in my county the Blue Cross offers 3 very different sets of HMO's (with quite similar names) on Healthcare.gov. One has a horribly narrow provider network, one is decent in my metro area, one is better outstate coverage. Guess which is cheapest? Yup. And this whole offering set varies from county-to-county across our state. Meanwhile their PPO is broad, period (again, in my geographic area). Drug formularies for all those 3 HMO's and 1 PPO are identical for this company - but that is here, and again may be different in your area. Bottom line, do the detailed comparison - beyond net premiums - check drugs (if that matters), doctor participation (if that matters), all costs, etc. Healthcare.gov provides the functionality to help you with those comparisons for the exact policies in your area (assuming your state uses Federal exchange, of course).

Best of luck. But yes, we're one of the families that are reasonably satisfied with our choice of plans.

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Watty
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Re: Health Insurance: Public-exchange ACA plans on HealthCare.gov - Do they have advantages over private plans?

Post by Watty » Fri Nov 08, 2019 8:48 pm

It gets into politics so it would be hard to discuss here where politics is not allowed but a few years ago there were some last minute changes to the ACA that were not really well thought out that backfired in states that were willing take advantage of the poorly planned change.

This resulted in an odd situation where some states will set up their healthcare exchange silver plans that the healthcare subsidy is based on to generate an even larger subsidy for everyone that qualifies for a subsidy on a policy that is bought through a healthcare exchange. The catch is that for people that do not qualify for the subsidy they can bypass the healthcare exchanges and buy policies for less outside the healthcare exchanges.

If you are sure that you will not be getting a subsidy then you should be sure to price what you can get both in and out of your healthcare exchange.

If you Google "silver switcheroo" and "silver loading" and maybe your state name you will find a lot more details on how this works and if your state has taken advantage of it.

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