*Membership spots not really limited!
S.F. Jude Terror wrote:Achilles - I have a Kaiser HMO and it is pretty awesome because A) Kaiser has everything you could need in-house, including a pharmacy and B) It's all paid for.
That being said, the Obamacare HMO is kind of shitty because it has PPO style copays and deductibles for everything. So it's not really like an HMO should be.
If you could get a decent HMO with low deductible and copays, then it would be better than a PPO for the money IMO.
Since I use care fairly often, I'm looking at a platinum plan, which would offer no deductible with 10% copays on things like hospitalizations or low copays for other services. This BTW is true of the HMOs, PPOs, and the EPOs under the platinum plan.
With the HMO, I'm a little concerned since I do have a surgery that I want, a fairly complex and specialized inpatient one, but one that would be elective. Basically, I wonder if they can deny me since the medical necessity isn't clear, it's more a lifestyle thing that would lessen some pretty severe chronic pain. Also I wonder how long it would take to get up the ladder from the GP to the specialist surgeon. As opposed to simply choosing my own surgeon. Though I do have the same concerns that they might not approve the surgery in the PPO.
Which leads to another issue. By ObamaCare law, state exchanges are required to post the ratings of these plans by 2016, so that consumers can tell how good they are. Most states aren't posting them yet, including California. According to the Fox News story, this is due to lobbying by the lower rated plans. Kaiser California BTW is rated #7 nationally, according to the story, while Blue Shield of California, which offers PPO and EPO, and IIRC also an HMO, is rated #414 nationally. Anthem Blue Cross of California, which I'm also interested in wasn't mentioned, nor do I know how to find those ratings.
I should mention here that the Covered California website is acting up a lot, and features are being taken off line periodically, making it very hard to compare the plans for which you qualify for subsides.
I really am going to have to schedule an appointment with one of those counsellors to figure out which plan I can afford, and which is the best.