Health plans on NY Exchange that allow for interstate claims?
December 3, 2015 7:13 AM Subscribe
I wonder if there are any plans on the New York Health Exchange that allow you to use doctors in another state? For someone who will be traveling a lot during the year?
You should be able to view that information when you're logged in to the exchange website. Try the filters on the left hav bar. One should let you select plans with out of state coverage. Fair warning, though, that there might not be any. I'm in the Texas exchange and there are no plans that cover out of state doctors on anything but an emergency basis.
posted by MsMolly at 9:18 AM on December 3, 2015 [1 favorite]
posted by MsMolly at 9:18 AM on December 3, 2015 [1 favorite]
I haven't seen any individual NY state plans that allow out of network coverage, no matter what the cost.
posted by poffin boffin at 9:41 AM on December 3, 2015 [1 favorite]
posted by poffin boffin at 9:41 AM on December 3, 2015 [1 favorite]
Not specific to NY exchange plans, but in general you're talking about two things: (1) does the plan have doctors/hospitals in their network for out-of-state providers? and (2) does the plan pay for out-of-network doctors?
You're likely to be better off financially if you can find a plan that has a wide network of doctors out of state--sometimes BCBS plans have this, although if you're looking specifically at plans in the exchange, I wouldn't hold my breath since having very narrow provider networks is one major way they control costs. Finding a plan that pays for out-of-network doctors is probably going to be easier--the insurance company will pay less of the cost (say, 60% instead of 80% of the bill) and you won't necessarily get the company's negotiated price discounts--but you will be covered at least partially.
In general, HMO and EPO provide no coverage at all outside of their network, so you probably don't want to go with one of these plans. Instead, you'd want to look for a PPO or POS plan--those will provide some coverage for out-of-network doctors. PPOs allow you to go directly to specialists, POS plans would require you to get a referral from your primary care doctor in order to go to a specialist. In general, I'd expect PPO plans to be the most expensive for the same level of coverage (bronze/silver/gold) and same general network size, reflecting the fact that you're buying more out-of-network coverage.
posted by iminurmefi at 9:59 AM on December 3, 2015 [1 favorite]
You're likely to be better off financially if you can find a plan that has a wide network of doctors out of state--sometimes BCBS plans have this, although if you're looking specifically at plans in the exchange, I wouldn't hold my breath since having very narrow provider networks is one major way they control costs. Finding a plan that pays for out-of-network doctors is probably going to be easier--the insurance company will pay less of the cost (say, 60% instead of 80% of the bill) and you won't necessarily get the company's negotiated price discounts--but you will be covered at least partially.
In general, HMO and EPO provide no coverage at all outside of their network, so you probably don't want to go with one of these plans. Instead, you'd want to look for a PPO or POS plan--those will provide some coverage for out-of-network doctors. PPOs allow you to go directly to specialists, POS plans would require you to get a referral from your primary care doctor in order to go to a specialist. In general, I'd expect PPO plans to be the most expensive for the same level of coverage (bronze/silver/gold) and same general network size, reflecting the fact that you're buying more out-of-network coverage.
posted by iminurmefi at 9:59 AM on December 3, 2015 [1 favorite]
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posted by COD at 8:24 AM on December 3, 2015