Florida ACA 2022

[JayP]

Looks like ACA plans for those living in Bushnell Florida do not offer very good out of state coverage. What are other Florida residents using for 2022? We just started full time and I need an ACA plan for the next 5 years. Should I change my domicile? If yes which state offers best nationwide coverage on an ACA plan?

[einmann]

What specifically have you seen in the ACA plans about poor out of state coverage? I've heard American and Canadian residents say they have Medevac plans that will take them to a hospital back home where they have better coverage.

[JayP]

I’ve gone into a few of the Florida Blue Cross Blue Shield ACA plans and searched for Doctors in areas like Colorado and Idaho and the in-network Doctors are almost non-existent.

[Jim & Wilma]

We had Fl Blue under ACA for a few years and used out of state docs almost exclusively. When you went out of state, you could use all of the BCBS providers under their BlueCard program. In network and out of network didn’t apply. See related FAQ out of state question. . . https://www.floridablue.com/members/tools-resources/faq-choosing-doctor-specialist-hospital

If I were you, I’d call a Fl Blue agent to double check and verify it still applies.

 

[JayP]

Thanks Jim and Wilma.

I do have an inquiry in to FBCBS on the BlueCard and whether it applies to the two plans I am reviewing. The ACA no longer has PPO plans for those who domicile in Bushnell, just HMO and EPO plans. Just trying to define and understand how these plans work out of state, which is where I’ll be 95% of the time.

[Jim & Wilma]

We had the 1443C plan which they called an PPO/EPO. We were very pleased with their network of providers.

Since the out of state provider list didn’t differentiate between in/out network, interestingly we found we had better selection outside of Florida.

Another thing I learned through this process was you’ll find the most attractive rates, if you can make your taxable income 150% of poverty level. 

[Blues]

On 11/12/2021 at 1:32 PM, JayP said:

I’ve gone into a few of the Florida Blue Cross Blue Shield ACA plans and searched for Doctors in areas like Colorado and Idaho and the in-network Doctors are almost non-existent.

You probably aren't searching correctly.  This happened in a thread on another forum, too, where someone claimed there were no in-network hospitals in New York City for Florida Blue subscribers, but I found 160 of them within a 25-mile radius.  I think that person's search technique was faulty, and no wonder, because it IS confusing.

Anyway, if you're on the "Find a Doctor" page of the Florida Blue website, if you're looking for providers outside Florida, don't use the big search boxes in the middle of the page.  My experience is that those find only doctors in the Florida Blue network, which is limited mainly to Florida (and is different even in Florida depending on whether you're looking at a Blue Options or a Blue Select plan).

To get providers outside the state, scroll down to Other Provider Services farther down on the left side, and click on Doctors and Hospitals Nationally.  That will take you to a BCBS provider finder.  There, you can enter your location and the plan.  I'm not sure what the difference is between the three Blue Card plans, and I know that if you pick Florida Blue as the plan, you get lots of out-of-state providers, but for some reason not as many as if you put in the three-letter prefix from the member number for a Florida Blue plan.

I would suggest that you look at this post and the ones after it. 

https://www.irv2.com/forums/f92/florida-aca-for-use-around-the-country-513716-4.html#post5974835

The issue is what is the difference is between Florida Blue's Blue Select and Blue Options plans, both when someone is in Florida and when someone is outside Florida, and some answers are being gleaned through gruntwork.

Edited November 14, 2021 by Blues

[Blues]

10 hours ago, JayP said:

The ACA no longer has PPO plans for those who domicile in Bushnell, just HMO and EPO plans.

As far back as I can remember, Florida Blue plans were EPO and not PPO.  When searching for plans, the only two filters for network were HMO and EPO.

I've never been really clear on the difference between an EPO and a PPO.  Neither requires referrals to specialists.  I saw some descriptions that say EPOs sometimes require you to designate a primary care physician, but Florida Blue EPOs don't.

I've also seen some explanations that EPOs don't cover out-of-network care, but Florida Blue plans do, albeit with a separate deductible and out-of-pocket limit.  But look at this Summary of Benefits for a Florida Blue EPO plan, starting on the second page where it lists the coverage for in-network and out-of-network care.  Lots of 50% coinsurance, but at least it's something, and it has a out-of-pocket limit.  Compare that to an EPO Ambetter plan in Florida, which says "Not covered" in the "out-of-network" column for everything but emergencies.

So Florida Blue EPO plans don't require referrals, don't require you to designate a primary care physician, and do have out-of-network coverage.  I''m sure there's some reason they're considered EPOs and not PPOs, but functionally, I can't see a difference.

[JayP]

You people have been very helpful, I thank you so much! I have been considering the 1443B EPO plan.  1443C is not offered to me on the healthcare.gov site, possibly due to my county but per the contract I will have the same out of state selection of doctors/hospitals etc. that any other FBCBS EPO Plan has. My income will be above the 150% but I will still get a very nice subsidy through the exchange.

I really feel sorry for people who can’t take the time necessary to understand all these plans. It’s really a lot to take in.