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Health insurance ASAP

I am a resident of NY and I work in NY too. My husband (40 y/o,healthy)and I (40 y/o, healthy) are looking to get our health insurance coverage from next present. Right now we are on cobra GHI( extension from my previous work place) but they are asking me to change to EMPIRE PPO or EPO since they will not have GHI. I did not have dental and vision coverage previously but even if I want it they are saying they cannot add it. They are also asking for a one year committment.
My questions:
Is there any individualized plans with not very high premium and good coverage in NY?
Is it true that even if I change from GHI to EMPIRE PPO/EPO I cannot have dental and vision plan?
What is the difference between EPO and PPO, which one is better.

Thank you.
2 Responses
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282113 tn?1388159749
MEDICAL PROFESSIONAL
Dear cherry271,

Here are the answers to your questions;

- Is there any individualized plans with not very high premium and good coverage in NY?

Overall, health insurance prices are higher in NY than most other states because;
1) Insurers can not decline any New Yorker based on health issues, (Called Guaranteed Issue)
2) Insurers can not charge premiums based on age of gender. (Called community rating)
So whether you are young or old, healthy or sick, you will be approved & pay the same!
Prices range from around $340(for hospital only plan)-$1995(for a more comprehensive HMO) per month for a couple. Couple of ways you can get better rates;
1) If one of you is Sole Proprietor business owner,
2) If you apply & enroll separately.

I recommend you to consult a licensed agent that represents companies like GHI or Empire Blue Cross Blue Shield. You can either find a local licensed agent or find a “licensed” online agency (like the one I work for; www.eHealthInsurance.com ).  You can call eHealth and speak to one of the licensed agents with any questions you may have.

- Is it true that even if I change from GHI to EMPIRE PPO/EPO I cannot have dental and vision plan?

This depends on what your previous employer has enrolled the other employees in.

- What is the difference between EPO and PPO, which one is better.

An EPO is an Exclusive Provider Organization. As a member of an EPO, you can use the doctors and hospitals within the EPO network, but cannot go outside of the network for care. So there are no out-of-network benefits other than life threatening emergencies.

PPO is a Preferred Provider Organization which allows you, as a member, to visit whatever in-network physician or healthcare provider you wish without first requiring a referral from a primary care physician. As a member of a PPO plan, you will not be required to choose a primary care physician, but may self-refer to specialists of your choice. Most services provided by Out-of-network providers may be covered at a lower benefit level.

Sincerely,

Amir Mostafaie
Helpful - 0
Avatar universal
An EPO is an HMO-like plan called an Exclusive Provider Organization. The EPO plan follows
the same guidelines as an HMO plan. You must obtain services from a contracted network
provider.
A PPO plan is a Preferred Provider Organization and allows in-network and out-of-
network treatment.

In my point of view...EPO is best.....

____________________
www.****.***
Helpful - 0

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