HMO Insurance ACA Marketplace

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Kikomoon
Kikomoon Member Posts: 350
edited November 2021 in Stage IV/Metastatic Breast Cancer ONLY

does anyone on here have any experience being on an ACA healthcare plan and how does that work with treatment? I have to see specialists all the time now. Would I have to get a referral from a PCP every month to go see my MO and RO??? I don’t see any PPOs available :

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  • Moissy
    Moissy Member Posts: 550
    edited November 2021

    Kikomoon- I purchased health insurance through the ACA marketplace for severalyears. In our area, we were always offered a choice of PPO, EPO and HMO plans, and I was always able to choose a plan that required no referrals. But if the insurance providers in your geographic area are only offering HMOs, you may only have that option. It's up to the insurance providers themselves what they offer. My insurance through ACA worked the same as any other private insurance that I ever had. No problems. I hope you can find a PPO or EPO plan if that’s what you prefer

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  • candy-678
    candy-678 Member Posts: 3,950
    edited November 2021

    I have had a PPO ACA plan since July (I had a choice of PPO or HMO in my area). Yes, I had to get referral letters from my PCP--- even for my established oncologist. That was kind of a pain at first--- July was busy with having PCP send insurance referral letters for all my established specialists. But, after that hiccup, the ACA plan is really good. No issues since.

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  • Piggy99
    Piggy99 Member Posts: 229
    edited November 2021

    Kikimoon, might be worth checking out the details of the HMO plans you are interested in. I’m not on ACA yet, but I did look into it to know what to expect for me and family when I’m not able to work anymore. My state also has HMO plans only, but the ones I looked at allow your PCP to give referrals that are good for a year for the specialists you see frequently. Still a pain to get it every year, but not as bad as needing approval for every visit like I was fearing.

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  • Kikomoon
    Kikomoon Member Posts: 350
    edited November 2021

    thank you Piggy and Candy for your replies. I can get a EPO but they won't cover my very expensive Tukysa, only the HMO. I did read in the fine print that you can apply for your specialist to be your PCP if you have a chronic condition. I wish everything wasn't such a mystery. Everyone I have spoken to in the insurance industry has told me to stick with my employers insurance for now. It is good insurance but I don't want to get pushed out because I'm raising everyone else's rates but even our insurance broker representative told me DO NOT worry about that, that I did not cause the rates to rise all by myself

    I was also considering that I may go on permanent disability sometime this year and would have to start over with deductibles and such, but I'll just cross that Bridge when I get there. We are going to put my husband on an EPO plan I think on the marketplace.

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  • Kikomoon
    Kikomoon Member Posts: 350
    edited November 2021

    thank you also moissy, it’s good to know your plan didn’t seem toodifferent from employers.

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