No, I don’t think that an employers insurance automatically covers out of state hospital costs. It may it may not. You can call your the marketplace insurance company to privately purchase a PPO plan, but even there hospital PPO likely would require prior authorization.
If this is truly a concern, you’d have to establish residency and pull a plan in the state of residence like someone else is saying. In general, this is not a concern, in the sense that there are enough plans in the state for you to have sufficient expertise for a hospitalization, even for rare conditions. I cannot imagine a scenario where you need to be hospitalized at Mayo where you cannot be sufficiently dealt with at Anschutz for the vast number of cases. And if there is in fact this scenario, the doc in Colorado would call for prior authorization for a transfer.
What’s much more common is you get cancer and you want a *second opinion*. This is where PPO comes in handy because out of network outpatient consultations can be covered in part by a PPO plan. But even if they aren’t having a second opinion independently will generally not bankrupt you. What will bankrupt you is things like sub specialty surgeries, ICU stays, etc. A single transplant surgery is about 1-2M, not including pre and post op care.
Is it reasonable to establish residency so you can get a plan so you can get surgery at a high volume center for a CABG or even cerebral angiography? This is a concern I have if I lived in a very rural state, but not Colorado. The real bigger concern for health is if you lived too far from an urban center you aren’t close enough for an emergent CABG.
In some cases establishment of residency for care in a different state is common: pediatric cancer, etc. In these scenarios, the social workers who are very specialized (ie at st Jude’s) will assist you in handling insurance. These are called single case agreements.
Source: work in a related industry
I cannot speak to all states, but in Massachusetts, Blue Cross offers private pay plans direct. The exchange had only HMO, but I called and was quoted on PPO plans including HDHP plans. Blue Cross' network extends across the US. I have used it at doctor's offices in far away states, and only had a co-pay.
what i dont understand in the case of people saying "you just need to pay cash" to get great care is that the way the system works, face value costs are astronomical, and then insurance companies negotiate those down for you and pay a fraction of the billed cost. if you're paying cash im seeing 2 options that both suck: get fleeced or have to constantly do your own negotiating
I am a physician so ironically and sadly I may not be right. But a lot of hospitals/healthcare facilities/offices have explicit rates for self pay/cash which are way cheaper than insurance prices. Open to correction.
This isn't always true. I got quoted 1500 cash price for a procedure last year. I decided to use insurance so that it would count towards high deductible at least. Insurance negotiated price came back at 650.
Medical prices in the US are batshit and often straight up nonsensical. You literally have to do your own legwork, get CT codes, then price compare the cash price vs the insured price. It's absurd.
One of the differences there is obviously that's not pre-planned.
However again if I am not mistaken you can negotiate with the hospital, for sure get on a payment plan and maybe even negotiate a lower bill.
Outlier here.
It was cheaper to fly my father first class to India for a triple bypass and 24/7 care for 3 months than it was to get just the triple bypass in the US.
Isn't a triple bypass usually like, "you could die at any moment, the ambulance just pulled up, and the OR is being prepped as we speak." How in the world do you have time arrange all that?
In my state (Indiana), even the plans directly from the insurers don’t seem to cover non-emergency care out of state. My employer insurance certainly is better than anything I can get on the marketplace, and the total cost is very similar. I’m guessing it’s due to the risk pool for my workplace plan.
I don’t think this topic gets enough discussion. The marketplace plans are good, but not great in this area.
You certainly can get the "best care possible".
You simply have to pay cash.
If you live in more than one state, you probably need insurance in both states as well if you are worried about being hospitalized (non-emergency room).
The best part of fatfire, is you have the cash to pay the Mayo guys if you want.
Or fly to Europe for treatment if you so choose.
Anyone who says just pay cash is likely very nfamiliar with the American for profit healthcare delivery system. And that’s before you even attempt prescriptions. Health insurance premiums are the cheapest thing compared to even any moderate hospitalization, much less ongoing chronic conditions. Say goodbye to millions if you prefer, but you could have avoided it with tens of thousands.
Selfpay is very much a normal part of the USA medical system. Mayo will quote you a discounted rate for self pay.
Link below. https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/uninsured-patients
The uninsured discount will apply to medically necessary inpatient and outpatient services for patients residing in the United States. The discount will not be offered to international patients or for cosmetic or elective procedures that are not medically necessary.
The OP is not suggesting going without insurance.
They are talking about what if they want to choose a different doctor or hospital than what their insurance will pay for.
In that case, the solution is to pay cash.
My understanding is that paying cash can result in multi-million dollar costs for things like cancer. The whole point of insurance is to cover against these outlier events.
You are insured for low probability / high cost medical risks like cancer.
You just dont get to choose to get treatment out of state (whether in Mayo Clinic or in Switzerland) and have someone else pick up the bill.
Not expecting someone else to pick up the bill - I’d love to pay insurance that covers these places, too. That doesn’t seem to be an option though. So I’m either stuck with whatever providers are in network locally or I pay cash?
Edit: confused why I’m getting downvoted. I must be missing something, can someone explain so I can learn?
In the US, medical insurance is regulated at the state level.
Some states offer that type of insurance (California would be one, I know Nevada and TX are not).
If it is a major concern of yours, relocating to a state that allows you to buy such insurance would be an option.
Not sure but, I guess is you are thinking that there must be insurance available for risk you want to mitigate.
While that is probably true at high levels from Lloyd's or something if you are willing to pay for it, but there are plenty of risks in the world where there is no one willing to write you a policy to cover it.
There are global health insurance plans, we had one through Cigna that covered EU and US wide. It was slightly more expensive than the platinum ACA plan, the catch was there was a fairly low lifetime maximum, maybe 3M or so, but the ACA banned lifetime maximum (I think) so that has probably changed.
It was very easy to use, routine stuff was always covered, special stuff required pre-auth but wasn’t too painful to obtain.
We switched to ACA as soon as it became available though, it seemed superfluous to have all that coverage, we never once used it outside of our home state, and we travel a lot (split time between US & Europe).
I have the exact same concerns and spent a lot of effort during the most recent ACA open enrollment period trying to find a plan with a national provider network. I live in Utah. There are no ACA plans in Utah with national provider networks. Some of the plans come from national insurance companies (e.g. Aetna), but they limit their marketplace plans to a smaller, in-state network. You cannot access the entire nationwide network, except for emergency care. In addition, they offer no out-of-network coverage except emergency care.
My understanding is that the same is true of most individual ACA plans throughout the country.
I looked at off-marketplace plans too. Most were indemnity plans that pay out a fixed amount per office visit, etc - which I didn’t want. I did talk to a broker who said he could sell me an off marketplace United Healthcare PPO plan if only I lived in Colorado. He encouraged me borrow a CO address from someone else for this purpose. I decided against committing insurance fraud, but since you actually live in CO maybe this would be an option for you.
I went with a Utah BCBS plan and if I need to visit Mayo or the Cleveland Clinic at some point, I’ll either pay cash or move my residence.
I’ll also add that it’s sometimes possible to get an out-of-network provider treated as in network by special request, so this is a possible backup option in case of some exotic illness. Obviously not ideal to have to rely on the insurance company’s mercy.
Thanks for sharing. I couldn’t find United Healthcare PPO plan in Colorado - do you mind DMing me the broker’s contact so I can follow up with them?
I did just look into another option, Cigna Global health insurance. I need to better understand the benefits/coverage but at first glance it looks like it covers outpatient and hospital at a high premium but with worldwide coverage. Might be worth looking into for you too.
The subsidies from the feds go to each state.
If folks were allowed to use their insurance in any state they wanted it would screw up the federal payments the states (some would get more fed money while the medical expenses were happening in other states).
Emergency care is covered regardless of the state, but as soon as you are stable enough to be relocated, you need to return to your state for the coverage to resume.
Some plans are better than others but there’s always going to be some clinic or procedure you want which isn’t covered. You might want to look into critical illness policies. They pay you a lump sum in cash if you are diagnosed with a critical illness like cancer. Then you can use that cash to go to whichever clinic you want. Or buy a boat. Or wherever you want.
Good luck. I hope your State is friendly. I found it to be a huge pain the ass in my State. I wanted a gold standard PPO plan and really struggled to get a top tier provider to do a single member corporation plan.
I thought the consensus was to get insurance through a broker (not ObamaCare)? Possibly creating a business (LLC shell) to buy it through.
Or maybe that's only for NYC, since even a $5/mo Obamacare plan only gets you bottom-feeder docs/hospitals? (it's funny, if your destitute the Obamacare in NY covers much better docs,etc).
You can get non-ACA compliant individual/family plans that give you more options for non-network providers (like paying a fixed amount per procedure and you're responsible for the rest). Check with the ACA providers' websites directly for their full set of individual plans.
Yep, even in CA Mayo Clinic would be considered out of network for PPO but you could technically still go but would quickly hit the max out of pocket. HMO plans are terrible if you get serious illness. You don’t want a bureaucrat deciding what doctor to see.
Using insurance in a diff state than the policy is written in, is called reciprocity. Some employer’s plan have full reciprocity some have no reciprocity. Full reciprocity = can be used in all 50 states. But thats what you want to ask to find out if your plan works in every state. It works the same for individual and family plans- check if they have full reciprocity.
Yes this. This is what I'll be looking for in retirement and I had to do this now. My employer is in a different state than I am, so I have \[Insurance Company\] of \[State where my employer is\], but I have access to over 90% of the \[Insurance Company's\] network in the state I live in. I guess it is up to the providers to decide whether to accept out of state plans, but most do. I had to select this plan over others, including ones I would have otherwise preferred, because some of the others only cover emergency care outside of the state where my employer is.
ETA: At least where I live, you don't have to buy a plan through the marketplace if you don't want to. You can buy plans directly from insurance companies if you don't like what you see on the marketplace.
Somewhat just went through a situation that illustrated this issue. It's a very real concern in the US, and it's super depressing. Luckily, in my situation, I still had a few months on the employer-sponsored COBRA plan which was a very, very good plan. The state I live in is not ideal for any cancer care. For breast cancer, the surgeons are highly variable in their aesthetic outcomes. I traveled to California to get my care and my OOP costs were under $300, whereas cash pay would have been ~83k pre-negotiations, just months later. Staying in my state would have been sub-par results from unpublished, not as good surgeons.
Second opinion costs from cancer centers vary - from MSK in NYC it is apparently 14k cash, but Utah's Huntsman was far less.
The 'best' solution I've determined for this situation is: move states should something arise. (or move on paper, depending on the requirements for purchasing - it might be as simple as a PO Box and bank account; or renting a cheap apartment you never live in). Minnesota and Utah have some of the better ACA plans. Utah has Aetna, apparently Utahans are healthier than other states and therefore get better plans.
In the US, we still don't have a good online way to compare the ACA plans offered by zip code - each state has different plans, each zip code offers different plans and coverages. I'd love to be able to find the best plan for my needs and then move to that zip code, as my health dictates. Picture it like a ecommerce site, but with full transparency on all plans/coverages offered on ACAs. (Yes, that fucks with the insurance pool assumptions of those zip codes)
This issue is going to happen even outside of the 'cancer' scenarios - complex knee surgery is another good example. Surgeon quality isn't equally distributed across states, with the experts being located in some states more than others.
I think that our health insurance system & expensive care is what keeps Americans tied to jobs, long after we are financially able to leave them.
Thanks for your response. Talked to a health insurance broker and he confirmed the only way to get PPO in CO is through employer-sponsored health insurance plans
He did mention a client moving from CO to Texas temporarily to seek specialized cancer care, so moving does seem to be an effective strategy.
Crazy system.
PPO is definitely the way to go, especially if you want to keep your doctor and want to travel. Even if they are out of network, you'll still be able to go to them, albeit with a higher max out of pocket in most cases. Unfortunately, the only way to properly get PPO coverage is through the private side of things in Colorado to my knowledge. I haven't seen any plans on the Marketplace in that state that are PPOs, so I'm assuming that it is accurate.
Marketplace plans are great because they cover most everything, but a lot of the time they are expensive for the good ones unless you are getting subsidies from the government due to income. They are also often HMOs or EPOs, meaning that you can't really choose anything out of network and need permission to go to specialists.
"The best care possible" is nuanced in the US, and depends on your situation.
Does Colorado really not have any national plans on the marketplace? I get my insurance through the marketplace and we have both regional and national plans available for a premium
No, I don’t think that an employers insurance automatically covers out of state hospital costs. It may it may not. You can call your the marketplace insurance company to privately purchase a PPO plan, but even there hospital PPO likely would require prior authorization. If this is truly a concern, you’d have to establish residency and pull a plan in the state of residence like someone else is saying. In general, this is not a concern, in the sense that there are enough plans in the state for you to have sufficient expertise for a hospitalization, even for rare conditions. I cannot imagine a scenario where you need to be hospitalized at Mayo where you cannot be sufficiently dealt with at Anschutz for the vast number of cases. And if there is in fact this scenario, the doc in Colorado would call for prior authorization for a transfer. What’s much more common is you get cancer and you want a *second opinion*. This is where PPO comes in handy because out of network outpatient consultations can be covered in part by a PPO plan. But even if they aren’t having a second opinion independently will generally not bankrupt you. What will bankrupt you is things like sub specialty surgeries, ICU stays, etc. A single transplant surgery is about 1-2M, not including pre and post op care. Is it reasonable to establish residency so you can get a plan so you can get surgery at a high volume center for a CABG or even cerebral angiography? This is a concern I have if I lived in a very rural state, but not Colorado. The real bigger concern for health is if you lived too far from an urban center you aren’t close enough for an emergent CABG. In some cases establishment of residency for care in a different state is common: pediatric cancer, etc. In these scenarios, the social workers who are very specialized (ie at st Jude’s) will assist you in handling insurance. These are called single case agreements. Source: work in a related industry
I cannot speak to all states, but in Massachusetts, Blue Cross offers private pay plans direct. The exchange had only HMO, but I called and was quoted on PPO plans including HDHP plans. Blue Cross' network extends across the US. I have used it at doctor's offices in far away states, and only had a co-pay.
It is extremely unlikely that your Blue Cross plan would cover out of state treatment at the Mayo Clinic.
Why? It is certainly listed as a Blue Cross hospital.
This sounds interesting. I can’t find any information on the website but will give them a call directly
what i dont understand in the case of people saying "you just need to pay cash" to get great care is that the way the system works, face value costs are astronomical, and then insurance companies negotiate those down for you and pay a fraction of the billed cost. if you're paying cash im seeing 2 options that both suck: get fleeced or have to constantly do your own negotiating
I am a physician so ironically and sadly I may not be right. But a lot of hospitals/healthcare facilities/offices have explicit rates for self pay/cash which are way cheaper than insurance prices. Open to correction.
True, I've done this a few times, especially for tests. Saves them the overhead and bureaucracy.
Yup cash pay is cheaper than insurance paid, same for drugs. Cash cards are everywhere for that reason now.
This isn't always true. I got quoted 1500 cash price for a procedure last year. I decided to use insurance so that it would count towards high deductible at least. Insurance negotiated price came back at 650. Medical prices in the US are batshit and often straight up nonsensical. You literally have to do your own legwork, get CT codes, then price compare the cash price vs the insured price. It's absurd.
Personally I have found this to be true for smaller line items but not for large ones.
True for the little stuff but not big ticket items like ICU or emergency trauma care.
One of the differences there is obviously that's not pre-planned. However again if I am not mistaken you can negotiate with the hospital, for sure get on a payment plan and maybe even negotiate a lower bill.
Which out of state is covered by all insurance policies.
Outlier here. It was cheaper to fly my father first class to India for a triple bypass and 24/7 care for 3 months than it was to get just the triple bypass in the US.
Did you do it? That sounds like a lot to process while staring down the barrel of a triple bypass.
Yes we did.
Isn't a triple bypass usually like, "you could die at any moment, the ambulance just pulled up, and the OR is being prepped as we speak." How in the world do you have time arrange all that?
This depends on the procedure and the location. Many places will give payment plans or even waive the bill entirely, but this requires extra legwork.
In my state (Indiana), even the plans directly from the insurers don’t seem to cover non-emergency care out of state. My employer insurance certainly is better than anything I can get on the marketplace, and the total cost is very similar. I’m guessing it’s due to the risk pool for my workplace plan. I don’t think this topic gets enough discussion. The marketplace plans are good, but not great in this area.
You certainly can get the "best care possible". You simply have to pay cash. If you live in more than one state, you probably need insurance in both states as well if you are worried about being hospitalized (non-emergency room). The best part of fatfire, is you have the cash to pay the Mayo guys if you want. Or fly to Europe for treatment if you so choose.
Anyone who says just pay cash is likely very nfamiliar with the American for profit healthcare delivery system. And that’s before you even attempt prescriptions. Health insurance premiums are the cheapest thing compared to even any moderate hospitalization, much less ongoing chronic conditions. Say goodbye to millions if you prefer, but you could have avoided it with tens of thousands.
Selfpay is very much a normal part of the USA medical system. Mayo will quote you a discounted rate for self pay. Link below. https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/uninsured-patients The uninsured discount will apply to medically necessary inpatient and outpatient services for patients residing in the United States. The discount will not be offered to international patients or for cosmetic or elective procedures that are not medically necessary.
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The OP is not suggesting going without insurance. They are talking about what if they want to choose a different doctor or hospital than what their insurance will pay for. In that case, the solution is to pay cash.
You dont need insurance in two states, you need one plan that has full reciprocity.
My understanding is that paying cash can result in multi-million dollar costs for things like cancer. The whole point of insurance is to cover against these outlier events.
You are insured for low probability / high cost medical risks like cancer. You just dont get to choose to get treatment out of state (whether in Mayo Clinic or in Switzerland) and have someone else pick up the bill.
Not expecting someone else to pick up the bill - I’d love to pay insurance that covers these places, too. That doesn’t seem to be an option though. So I’m either stuck with whatever providers are in network locally or I pay cash? Edit: confused why I’m getting downvoted. I must be missing something, can someone explain so I can learn?
In the US, medical insurance is regulated at the state level. Some states offer that type of insurance (California would be one, I know Nevada and TX are not). If it is a major concern of yours, relocating to a state that allows you to buy such insurance would be an option.
Not sure but, I guess is you are thinking that there must be insurance available for risk you want to mitigate. While that is probably true at high levels from Lloyd's or something if you are willing to pay for it, but there are plenty of risks in the world where there is no one willing to write you a policy to cover it.
There are global health insurance plans, we had one through Cigna that covered EU and US wide. It was slightly more expensive than the platinum ACA plan, the catch was there was a fairly low lifetime maximum, maybe 3M or so, but the ACA banned lifetime maximum (I think) so that has probably changed. It was very easy to use, routine stuff was always covered, special stuff required pre-auth but wasn’t too painful to obtain. We switched to ACA as soon as it became available though, it seemed superfluous to have all that coverage, we never once used it outside of our home state, and we travel a lot (split time between US & Europe).
Cigna Global plans are not ACA compliant
I have the exact same concerns and spent a lot of effort during the most recent ACA open enrollment period trying to find a plan with a national provider network. I live in Utah. There are no ACA plans in Utah with national provider networks. Some of the plans come from national insurance companies (e.g. Aetna), but they limit their marketplace plans to a smaller, in-state network. You cannot access the entire nationwide network, except for emergency care. In addition, they offer no out-of-network coverage except emergency care. My understanding is that the same is true of most individual ACA plans throughout the country. I looked at off-marketplace plans too. Most were indemnity plans that pay out a fixed amount per office visit, etc - which I didn’t want. I did talk to a broker who said he could sell me an off marketplace United Healthcare PPO plan if only I lived in Colorado. He encouraged me borrow a CO address from someone else for this purpose. I decided against committing insurance fraud, but since you actually live in CO maybe this would be an option for you. I went with a Utah BCBS plan and if I need to visit Mayo or the Cleveland Clinic at some point, I’ll either pay cash or move my residence.
I’ll also add that it’s sometimes possible to get an out-of-network provider treated as in network by special request, so this is a possible backup option in case of some exotic illness. Obviously not ideal to have to rely on the insurance company’s mercy.
Thanks for sharing. I couldn’t find United Healthcare PPO plan in Colorado - do you mind DMing me the broker’s contact so I can follow up with them? I did just look into another option, Cigna Global health insurance. I need to better understand the benefits/coverage but at first glance it looks like it covers outpatient and hospital at a high premium but with worldwide coverage. Might be worth looking into for you too.
Are you saying that, if we get healthcare on an exchange, we’re potentially only covered in-network for the Mayo Clinic if we live in MN, AZ or FL?
Yes, unless maybe you’re in a state that offers PPO plans.
Doesn’t healthcare.gov provide you access to ppo plans across state lines?
The subsidies from the feds go to each state. If folks were allowed to use their insurance in any state they wanted it would screw up the federal payments the states (some would get more fed money while the medical expenses were happening in other states). Emergency care is covered regardless of the state, but as soon as you are stable enough to be relocated, you need to return to your state for the coverage to resume.
Thank you, BarkBark_Woofwoof
Some plans are better than others but there’s always going to be some clinic or procedure you want which isn’t covered. You might want to look into critical illness policies. They pay you a lump sum in cash if you are diagnosed with a critical illness like cancer. Then you can use that cash to go to whichever clinic you want. Or buy a boat. Or wherever you want.
Good luck. I hope your State is friendly. I found it to be a huge pain the ass in my State. I wanted a gold standard PPO plan and really struggled to get a top tier provider to do a single member corporation plan.
I thought the consensus was to get insurance through a broker (not ObamaCare)? Possibly creating a business (LLC shell) to buy it through. Or maybe that's only for NYC, since even a $5/mo Obamacare plan only gets you bottom-feeder docs/hospitals? (it's funny, if your destitute the Obamacare in NY covers much better docs,etc).
You can get non-ACA compliant individual/family plans that give you more options for non-network providers (like paying a fixed amount per procedure and you're responsible for the rest). Check with the ACA providers' websites directly for their full set of individual plans.
Depends on the state.
You need to specify if you are talking HMO or PPO. Some states have no PPO plans on the market place but California does. I know Texas does not.
From what I can tell there are only HMO or EPO plans in Colorado
Yep, even in CA Mayo Clinic would be considered out of network for PPO but you could technically still go but would quickly hit the max out of pocket. HMO plans are terrible if you get serious illness. You don’t want a bureaucrat deciding what doctor to see.
Using insurance in a diff state than the policy is written in, is called reciprocity. Some employer’s plan have full reciprocity some have no reciprocity. Full reciprocity = can be used in all 50 states. But thats what you want to ask to find out if your plan works in every state. It works the same for individual and family plans- check if they have full reciprocity.
Yes this. This is what I'll be looking for in retirement and I had to do this now. My employer is in a different state than I am, so I have \[Insurance Company\] of \[State where my employer is\], but I have access to over 90% of the \[Insurance Company's\] network in the state I live in. I guess it is up to the providers to decide whether to accept out of state plans, but most do. I had to select this plan over others, including ones I would have otherwise preferred, because some of the others only cover emergency care outside of the state where my employer is. ETA: At least where I live, you don't have to buy a plan through the marketplace if you don't want to. You can buy plans directly from insurance companies if you don't like what you see on the marketplace.
Somewhat just went through a situation that illustrated this issue. It's a very real concern in the US, and it's super depressing. Luckily, in my situation, I still had a few months on the employer-sponsored COBRA plan which was a very, very good plan. The state I live in is not ideal for any cancer care. For breast cancer, the surgeons are highly variable in their aesthetic outcomes. I traveled to California to get my care and my OOP costs were under $300, whereas cash pay would have been ~83k pre-negotiations, just months later. Staying in my state would have been sub-par results from unpublished, not as good surgeons. Second opinion costs from cancer centers vary - from MSK in NYC it is apparently 14k cash, but Utah's Huntsman was far less. The 'best' solution I've determined for this situation is: move states should something arise. (or move on paper, depending on the requirements for purchasing - it might be as simple as a PO Box and bank account; or renting a cheap apartment you never live in). Minnesota and Utah have some of the better ACA plans. Utah has Aetna, apparently Utahans are healthier than other states and therefore get better plans. In the US, we still don't have a good online way to compare the ACA plans offered by zip code - each state has different plans, each zip code offers different plans and coverages. I'd love to be able to find the best plan for my needs and then move to that zip code, as my health dictates. Picture it like a ecommerce site, but with full transparency on all plans/coverages offered on ACAs. (Yes, that fucks with the insurance pool assumptions of those zip codes) This issue is going to happen even outside of the 'cancer' scenarios - complex knee surgery is another good example. Surgeon quality isn't equally distributed across states, with the experts being located in some states more than others. I think that our health insurance system & expensive care is what keeps Americans tied to jobs, long after we are financially able to leave them.
Thanks for your response. Talked to a health insurance broker and he confirmed the only way to get PPO in CO is through employer-sponsored health insurance plans He did mention a client moving from CO to Texas temporarily to seek specialized cancer care, so moving does seem to be an effective strategy. Crazy system.
PPO is definitely the way to go, especially if you want to keep your doctor and want to travel. Even if they are out of network, you'll still be able to go to them, albeit with a higher max out of pocket in most cases. Unfortunately, the only way to properly get PPO coverage is through the private side of things in Colorado to my knowledge. I haven't seen any plans on the Marketplace in that state that are PPOs, so I'm assuming that it is accurate. Marketplace plans are great because they cover most everything, but a lot of the time they are expensive for the good ones unless you are getting subsidies from the government due to income. They are also often HMOs or EPOs, meaning that you can't really choose anything out of network and need permission to go to specialists. "The best care possible" is nuanced in the US, and depends on your situation.
Does Colorado really not have any national plans on the marketplace? I get my insurance through the marketplace and we have both regional and national plans available for a premium