Personal Finance (Not Investing) • Best Way To Find Non-ACA Medical Insurance?

Not necessarily. The insurer could offer 2 PPO products, at different prices, with different risk pools for the individual market vs employer market, the same way they already offer 2 HMO products with different risk pools between these markets. But it seems many insurers are making the decision to offer PPO products only for the employer market, at least in the case of the state's OP.

I wasn't talking about whether an insurance company could offer a PPO voluntarily. Of course they can.

I was replying to your question about why states don't force the insurance companies to offer a PPO on the individual market if they offer a PPO on the small groups market.

In a passive exchange model, the state cannot control what plans are offered on the exchange. The state can only merge the individual and small group markets. That would force them to offer the same product to individuals and small groups because there is only a single market for both types of customers. However, even that doesn't force the insurers to offer PPOs because they could decide to offer only HMOs on the combined market.

There are a few states that have active purchaser exchanges. However, most states have passive exchanges. The federal exchange is also passive.

But why don’t they? That is essentially the gist of OPs question. And a question I have always wondered as well. Why, as a business owner, can I purchase a wide variety of PPO plan options at a spectrum of costs from major national insurers for my employees, but as an individual, I cannot purchase a single PPO plan for any price regardless of age and health status? Why are insurers willing to take on the liability of future employee health expenditures that they won’t accept for those who are self-employed or early-retired? Is it a rational business decision by the national insurers? Or is there some regulatory reason that prevents the national insurers from offering PPO plans either on or off the ACA marketplace? It just doesn’t make business sense to me.

Statistics: Posted by investorpeter — Tue Apr 23, 2024 5:49 pm — Replies 80 — Views 4904

---