Florida to Stop Selling PPO Plans by 2016

Cropped SingleCare logo By | October 29, 2015

With the Affordable Care Act (ACA) in effect, the insurance options available to Floridians are changing. Make sure to stay informed, so you know which type of coverage is right for you.

In January 2016, new rates will go into effect for Florida healthcare plans in accordance with the Affordable Care Act. Floridians should expect changes to the roster of available plans they can choose from through the federal healthcare marketplace. What types of changes? Many of these plans are now being classified as “EPOs,” a term that has many people scratching their heads.

Health insurance can be complicated, especially when navigating the balance between paying an affordable rate and making sure you have an adequate level of coverage. This article outlines all the options available to Floridians, including some new ones that could help you to meet all your healthcare needs at an affordable cost.

Your Guide to HMOs, PPOs, and EPOs

Let’s start with a quick review of the different types of plans.

In a Health Maintenance Organization (HMO), your Primary Care Physician (PCP) acts as a gatekeeper. When you want to see a specialist, your PCP refers you to other in-network providers and doctors who have signed a contract with the HMO. Treatment from doctors who aren’t connected to the HMO is referred to as out-of-network care, and is only covered in an emergency. You pay a monthly premium and a fee called a “co-pay” at the time of your appointment.

A Preferred Provider Organization (PPO) is a type of insurance that generally offers more options than an HMO, but also requires you to share a greater percentage of the costs with your insurer. The key difference is that a PPO includes coverage to see out-of-network providers, whereas an HMO only covers you for doctors and hospitals within its network and requires a referral from your primary care physician before it will cover your expenses.

In 2016, these PPOs will disappear from Florida’s health exchange. Instead, Floridians who purchase insurance through the exchange must choose between HMOs and EPOs.

An Exclusive Provider Organization (EPO) only covers care within its network of providers and asks patients to pay through premiums and co-pays, much like an HMO. But unlike HMOs, EPOs allow you to see in-network specialists without a referral. What’s the catch? An EPO’s network is typically smaller than that offered by an HMO or PPO. For more information on the similarities and differences between these plans, Nerdwallet has a good chart summarizing them.

What Does This Mean for You?

Florida residents have some tough decisions to make — they need to balance the care they want with the prices they can afford. If they sign up through the exchange, they’ll have to choose from an EPO or an HMO that may not offer as large a network or the flexibility that a PPO would have.

This is a potentially risky trade-off: if your preferred doctor or hospital isn’t in your network, you won’t be covered for the cost of treatment. And without a PPO option for covered out-of-network care, you might not be able to see the doctor you want, even if it’s a doctor you’ve seen before.

What’s more, if you find yourself in a situation where you need out-of-network care, an EPO could leave you with massive bills. WCGU Public Media notes that, “with EPOs, if a person ends up in the hospital and gets an out-of-network doctor, they may have to pay for that treatment in full.”

How to Get the Care You Want

The good news is that, as an informed consumer, you can build your own perfect plan by pairing health insurance with a discounted health care services program like SingleCare.

SingleCare helps limit your costs while filling in the gaps in your coverage. Your preferred specialist doesn’t accept your insurance? No problem. Use SingleCare for savings of up to 50% to see whichever specialist you need. Need an appointment at a convenient, but out-of-network location? Again, not a problem. With SingleCare, you can access necessary services at affordable prices.

Take confidence that you’ll have the care you need in 2016 with SingleCare. By offering competitive pricing across a large network of providers, SingleCare makes it possible to see the doctors you want without breaking the bank.

(Main image credit: Al Muya/flickr)