Key Differences Between Florida Blue and myBlue Health Plans

Florida Blue and myBlue are both popular health insurance options in Florida, but they have some key differences in terms of plan types, provider networks, and costs. Understanding these differences can help you determine which type of plan may be a better fit for your needs and budget.

Overview of Florida Blue and myBlue

Florida Blue is the trade name for Blue Cross and Blue Shield of Florida. This large insurer offers a variety of health plan options including:

• PPO plans like BlueOptions and BlueSelect
• HMO plans like BlueCare and SimplyBlue
• High-deductible plans eligible for a Health Savings Account

myBlue is a type of HMO plan offered by Florida Blue. It features set copays for certain services and coinsurance on others.

Below we’ll explain the main differences between these two plan types from Florida Blue.

How Florida Blue PPO and HMO Plans Differ

Florida Blue offers both PPO and HMO plans. Here are some of the key ways these two plan types differ:

• Provider network – PPOs have a large network of providers you can see. HMOs like myBlue have a narrower network.

• Primary care – HMOs require you to choose a primary care physician to coordinate care. PPOs allow you to see any in-network doctor.

• Referrals – HMOs usually require referrals from your PCP to see specialists. PPOs allow self-referrals to any network specialist.

• Out-of-network coverage – PPOs offer out-of-network benefits. HMOs like myBlue only cover out-of-network care in emergencies.

• Costs – HMOs tend to have lower premiums but set copays for services. PPOs have higher premiums but coverage is based on coinsurance after the deductible.

How myBlue HMO Plans Work

myBlue is a type of HMO plan from Florida Blue centered around your selected primary care physician. Here’s an overview of how myBlue HMO plans work:

• You choose a primary care doctor from the myBlue network who coordinates your care.

• For most services you pay a set copay – for example, $25 for a primary care visit.

• Some services are covered with coinsurance after you meet the deductible, for example 20% of the cost for an MRI.

• These plans feature a limited network of providers. You must get referrals from your primary care doctor to see network specialists.

• There is no out-of-network coverage except for emergencies. You would pay the full cost for seeing out-of-network providers.

• Premiums tend to be lower compared to PPO plans since the network is smaller.

myBlue plans aim to provide coordinated care led by your primary doctor. The trade-off is you have less flexibility to see specialists or providers outside the network except for emergencies.

Cost Differences Between Florida Blue and myBlue

There can be significant cost differences between Florida Blue PPOs and myBlue HMO plans:

• Premiums – myBlue premiums are usually lower than PPO premiums by as much as 30-40% for the same level of coverage.

• Copays vs coinsurance – myBlue has copays for services while PPOs are based on coinsurance after the deductible. Copays can make costs more predictable.

• Deductible – myBlue plans tend to have a deductible around $1,000 while PPO deductibles may be $2,000 or higher.

• Max out-of-pocket limit – The most you would pay for covered care in a year is $2,500 to $4,000 with myBlue vs. $5,000 or more with many PPO plans.

While every individual and family’s coverage needs are different, the lower premiums, copays, and max out-of-pocket costs of myBlue plans can make them very affordable compared to PPOs.

Who Should Consider myBlue vs Florida Blue PPOs

Here are some factors to help determine if myBlue or a Florida Blue PPO may be a better choice:

myBlue may be better if you:

• Want lower premiums
• Don’t need as much provider choice
• Prefer copays over coinsurance
• Seek a primary doctor to coordinate care
• Have limited health issues

A Florida Blue PPO may be better if you:

• Want access to a large national network
• Prefer flexibility in choosing providers
• Have unpredictable healthcare needs
• See many specialists or prefer self-referrals
• Travel frequently within the United States

In the end, choosing between myBlue vs a Florida Blue PPO depends on your priorities in terms of costs, provider access, and care management preferences. Comparing plans can help determine the right balance for your situation.

Can You Switch Between Florida Blue and myBlue Plans?

When shopping for 2023 health insurance coverage during open enrollment, you can switch between Florida Blue and myBlue plans:

• Those enrolled in a PPO can change to a myBlue plan for 2023 if they meet eligibility requirements.

• Those who currently have a myBlue plan can switch to a BlueOptions or BlueSelect PPO from Florida Blue instead for the upcoming year.

• You cannot changeinsurance plans outside of open enrollment unless you have a qualifying life event like marriage, divorce, or job loss.

• Be aware that changing plan types could mean you need to find new providers in your new plan’s network.

So during open enrollment each year, Florida Blue members can evaluate options and determine whether a myBlue plan or PPO fits their current needs better. Just remember provider networks differ between plan types.

Which Plan Type Is Right for You?

Deciding whether myBlue or a Florida Blue PPO works better requires looking at your specific situation:

• Do you want lower premiums or more provider choice?
• How much does having referrals to specialists impact you?
• Will you likely hit the higher PPO deductible and out-of-pocket max?
• Do you have any upcoming procedures or medical needs?

By understanding all the costs, coverage details, provider networks and plan administration differences outlined above, you can determine which type of Florida Blue plan makes the most sense for the year ahead.

The Bottom Line

myBlue HMO plans and Florida Blue PPOs take very different approaches to balancing costs, provider access, and care management. While myBlue plans offer affordability through their limited networks and set copays, PPOs provide more provider choice and flexibility. Review your options thoroughly during open enrollment to find the right plan fit based on your healthcare priorities and budget.