Going from PPO to HMO on Obamacare

Going from PPO to HMO on Obamacare


I’ve had a Blue Cross silver PPO plan for $155/month getting probably near the max subsidy. The same plan in 2018 would be $665/mo so I was put into the HMO version at $245/mo. Zero annual deductible, $1300 max annual out of pocket. Any negatives to this change if all my current docs accept this insurance?


This is the response wiki post. You can edit this out for your response.


What the heck is a response wiki post?


See the thread about wiki/summaries. It was a feature on FW Forums.


Can’t all users edit any post now by just adding a reply?


If you picked a doctor and network that has the providers that you typically use, you should likely spend a lot less on healthcare. Even though HMO has a bad reputation, remember Kaiser (top ranked health system in the country) is fully HMO. So, whatever care you need should be no issue, you just have to have your PCP make the request.



There is an issue where you will now need a referral from your PCP for a specialist. This is not really a big deal since most people go to their PCP first anyways.


I’m with Kaiser right now and I really like it. Every visit is electronically logged and I can email questions and ask for med refill via messaging. Seeing a specialist is also easy with no more wait time than typical specialist appt. HMO does have a bad rap but IMO it’s undeserved. They manage cost by not paying for certain things that are scientifically unproven.

However, not HMO are created the same. Kaiser is one of the top rated in the nation.


Checked the plan details and no referral needed for specialists. My only two concerns are if for example I’m out of town for 2 weeks, get sick and have to see a doc, or get some disease that would be handled better by an out of area doc.Neither very likely but… Also, are hospitals members of the HMO like the doctors are, or can you go to any hospital?


Yes, the provider group you pick for your PCP also has certain preferred hospitals as usually both the hospital and provider group have to contract together to get the incentives from the HMO. So, you need to usually make sure your preferred hospitals and providers are in the same group. This is normal from a geographic perspective, but sometimes doesn’t work for everyone.

Again, not sure why the hospitals matters for most (you don’t want to go to the hospital), but if the hospital is important, you have to find a provider group that uses that hospital for primary services which may take you away from your preferred doctors.



Sounds good. What state is this?


Haven’t thought of them before but see they have 4 silver plan available between $98 and $22. Not too different from the $245 BC plan. Why so much cheaper? Is it the $775 subsidy just making it look much cheaper?




You would get the same $ subsidy for any plan you chose. So no, the subsidy does’t make one plan cheaper than the others.

Kaiser is often the cheapest option here in OR too.


It’s the answer you get when you don’t like any of the others. :wink:

That was an incredible rate for the PPO. The HMO rate seems excellent also, especially with the $0 deductible. It’s not good enough for me to move to DE, though. :grin:


I had a $600 POS this year, next year its $600 for HMO. All my docs are out of network. $600 for HMO for a single person is horrible.