I live in Texas and I’m self-employed. Health insurance here is really expensive, and it seems like only small businesses can get PPO plans.
I’ve heard that in California, individuals can get PPO plans and that insurance is cheaper overall. Is that actually true?
I’m 55, so having good insurance is important. Would moving to California make a big difference in cost and coverage? Appreciate any advice.
Check Covered California and search for PPO plans in the area you’re thinking about. Some counties have PPO options, but they can still be pricey unless you qualify for subsidies.
I wouldn’t call California’s health insurance cheap. In high-cost areas like Los Angeles and San Francisco, it’s pretty expensive.
The best way to figure out costs is to go to Covered California’s official site and enter your income and household details. Be careful—some sites look similar but aren’t official. The real one won’t ask for personal details just to show plan options.
Subsidies come from federal tax credits, so those don’t change from state to state.
Texas is definitely one of the more expensive states for health insurance. I don’t know much about California’s market, but in the states where I sell plans, Texas tends to be on the higher end.
Also, Texas doesn’t offer PPOs on the ACA marketplace. You can only get them through employers or private insurance. Just be careful with private plans—they aren’t ACA-compliant and may not cover pre-existing conditions.
@Ash
If you don’t have pre-existing conditions, private plans can work. But if you do, it’s safer to go with an ACA plan.
Sam said:
@Ash
If you don’t have pre-existing conditions, private plans can work. But if you do, it’s safer to go with an ACA plan.
Exactly. That’s why I don’t recommend private plans if you have existing health issues.
@Ash
I have high blood pressure and diabetes, so that’s my biggest concern. I recently got a quote for a BCBS PPO plan at nearly $3.5k per month for my family. That’s a crazy price. I’m considering moving to California or Washington for retirement, and healthcare costs are a big factor.
@True
If you need coverage for diabetes and high blood pressure, an ACA plan is your best bet.
I know they’re expensive, but they guarantee coverage for pre-existing conditions. One way to cut costs might be splitting the family up—put yourself on an ACA plan and the rest on a private plan if they don’t have major health issues.
@Ash
Thanks. I’ll ask my agent if the BCBS PPO plan they offered actually covers pre-existing conditions.
True said:
@Ash
Thanks. I’ll ask my agent if the BCBS PPO plan they offered actually covers pre-existing conditions.
If it’s an ACA plan, it should cover everything. But I don’t think there are BCBS PPO plans on the ACA in Texas.
$3,500 sounds really high, even for a family plan. If it’s that expensive, it’s probably a top-tier plan. You might be able to lower the cost by increasing your deductible, adjusting copays, or switching to an HMO.
Since you’re self-employed, estimating income can be tricky, but if you qualify, you might get subsidies to bring the cost down.
Sam said:
@Ash
If you don’t have pre-existing conditions, private plans can work. But if you do, it’s safer to go with an ACA plan.
I don’t know much about ACA plans. I’ve always had employer coverage and recently switched to COBRA. Do ACA plans even offer PPOs?
@True
I have a small business, so I skipped ACA PPOs because they were too expensive. I went with a private plan that includes health, dental, and vision at a better rate.
Sam said:
@True
I have a small business, so I skipped ACA PPOs because they were too expensive. I went with a private plan that includes health, dental, and vision at a better rate.
Do health insurance agents also offer ACA PPO plans? Mine didn’t even mention ACA as an option.
@True
My advisor showed me all the available plans in my state, both ACA and private PPOs.
Sam said:
@True
COBRA is known to be expensive. Is that true in your case?
Compared to private insurance, COBRA is still cheaper for me.
@True
There are no PPO plans on the ACA marketplace in Texas. The closest option is Blue Advantage Plus, which is a POS plan. Just make sure it includes ‘PLUS’ in the name, because regular Blue Advantage plans are HMOs. The Plus plans are the only marketplace options in Texas that cover out-of-network care, but they have a $15,000 out-of-network deductible and only pay 50% after that, with no out-of-pocket max.
Sam said:
@Zev
Private plans are available year-round. If he qualifies for a special enrollment period, he can switch to an ACA plan.
Private plans aren’t ACA-compliant. Since OP has diabetes and high blood pressure, private plans won’t be a good fit. Those plans either won’t accept diabetics or won’t cover pre-existing conditions.
@Zev
Thanks. I need to research private plans more. My agent gave me a PPO quote but didn’t ask about my pre-existing conditions.
I keep hearing about healthcare.gov. Is it better than COBRA? My current PPO plan is through COBRA, and I’m okay with it for now.
True said:
I keep hearing about healthcare.gov. Is it better than COBRA? My current PPO plan is through COBRA, and I’m okay with it for now.
California has its own ACA marketplace, Covered California, instead of healthcare.gov. You can check the prices there and compare them to your COBRA plan.