HMO or PPO?? - Mothering Forums

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#1 of 11 Old 12-02-2009, 08:00 PM - Thread Starter
 
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Hi,
Today is the last day for us to choose our health insurance option - yikes am I a procrastinator!

I just want to get some views on HMO vs PPO. We have always chosen the PPO option. In the past both options were totally covered by my dh's company but this year there will be a fee for the PPO and not the HMO.

Thoughts on the two types of insurance? Good/bad experiences with HMO vs PPO or vice versa?

SJ
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#2 of 11 Old 12-02-2009, 08:26 PM
 
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I've always preferred PPOs just b/c you have more freedom (as in choice of providers.) Some providers are preferred and would have better coverage, but typically even out of network providers are covered at some percentage.

With an HMO, you only have coverage with network providers, period.
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#3 of 11 Old 12-02-2009, 09:13 PM
 
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I have had bad experiences with HMO's. limited options.

DS 5-11-06
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#4 of 11 Old 12-02-2009, 09:30 PM
 
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HMOs have limited provider options, and you HAVE to pick a primary care provider who then must submit a referral for you to see a specialist (except for OB/Gyn). BUT! Look carefully at your paperwork. Sometimes PPOs offer limited lifetime coverage in exchange for that flexibility. Check it out.
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#5 of 11 Old 12-02-2009, 09:34 PM
 
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the only difference I've encountered have been that the HMO's I've had did not have a deductible but the PPO and POS have had deductibles. I don't know if this is always the case or just the plans I've had. DH's insurance is at open enrollment right now and he's switching to a PPO because it's fully covered by his work and why not have out of network options if there is no charge? I wouldn't do it if we had to pay.

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#6 of 11 Old 12-02-2009, 09:58 PM
 
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We had the HMO and PPO option at work but now we only have a PPO or HealthFund option. I usually went with the PPO because of the choice and it included broader care like acupuncture. However, we knew DS would need a surgery and it was going to be costly. So we switched to the HMO for the whole year and WOW did we save money. We only ended up paying $150 tops for the precare, surgery (4 day hospital stay) and follow up appointments.

We were going to stay with the HMO but they changed the offerings at work. And since we’re on this topic I thought I toss out info on this new HealthFund thing Aetna is doing because I think more of us will be seeing it in the future.

Instead of us paying copays, deductibles and percentages…. The insurance company has a total dollar amount (the HealthFund) banked for you. The amount varies based on number of dependants. All well child, shots and once a year adult physicals are free – no money is taken out of the Healthfund. But all other doctor visits are paid via the fund 100%. Prescriptions are under a different plan so not included in the fund money. When you reach the maximum of your Fund, you in turn have to pay 100% of your doctor bills until you match the dollar amount. After that point it returns to a standard PPO copay/percentage type deal.

It’s a great option if you don’t have major issues or need surgery. Perfect for younger singles. As a family of 3 we’ve done well. Both years we’ve money roll over so our Fund is a bit cushy…. But there is always that worry about tapping it out. You also get used to asking what things cost! But like a PPO you get to choose your Doctors and Specialists, at InNetwork savings. We just signed up for year 3 on the HealthFund and hope it pans out again for us.

Rhianna
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#7 of 11 Old 12-02-2009, 10:59 PM
 
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It really depends on the HMO.

I've had an HMO (Kaiser) for years. They cover literally everything in house, and it was much cheaper than the PPO option, which didn't cover everything (for example, infertility was covered 50% under the HMO, but not at all under PPO). The exception to that being homebirth, which is not covered at all under HMO, but is covered partially under PPO.

So it really depends on where your priorities lie and what exactly your options are, because not all HMOs (or all PPOs) are the same.

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#8 of 11 Old 12-02-2009, 11:19 PM - Thread Starter
 
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Thanks for the replies everyone! Keep 'em coming!

FWIW, the HMO is Cigna and the PPO is Blue Cross Blue Shield. On paper it looks like the Cigna covers pretty much everything as long as it is under an in network provider. BCBS has a $200 indiv deductible and $600 family deductible, it has many areas that are covered at 100% AFTER the deductible is met. Non-network providers are covered at 60% and with certain care that is AFTER the deductible.

I am leaning towards the HMO but I still get nervous about the noncoverage for non-network providers (though that has never been an issue), the freedom to choose to go to a specialist (yet has never been needed) and I worry the HMO may decline coverage for us if something does go wrong with our health (even though we are all very healthy). bah. I guess I have gotten used to having a lot of options though I've only used them on a few occaisions (homebirth and chiropractic).
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#9 of 11 Old 12-03-2009, 06:44 PM
 
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Quote:
Originally Posted by MissSJ View Post
Thanks for the replies everyone! Keep 'em coming!

FWIW, the HMO is Cigna and the PPO is Blue Cross Blue Shield. On paper it looks like the Cigna covers pretty much everything as long as it is under an in network provider. BCBS has a $200 indiv deductible and $600 family deductible, it has many areas that are covered at 100% AFTER the deductible is met. Non-network providers are covered at 60% and with certain care that is AFTER the deductible.

I am leaning towards the HMO but I still get nervous about the noncoverage for non-network providers (though that has never been an issue), the freedom to choose to go to a specialist (yet has never been needed) and I worry the HMO may decline coverage for us if something does go wrong with our health (even though we are all very healthy). bah. I guess I have gotten used to having a lot of options though I've only used them on a few occaisions (homebirth and chiropractic).
The PPO has a very low deductible; that's nice. With that low a deductible, I'd take the PPO, though I still recommend you compare the lifetime payout limits on both your plans.
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#10 of 11 Old 12-03-2009, 06:53 PM
 
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That's extremely low for a BCBS PPO deductible. I'd do that one in your circumstance. FWIW, their out of network for us is pretty lenient in many ways. It's still covered in full if there isn't an in network equivalent in whatever area and speciality. And they have a really huge network anyway.

In the last few years we've suddenly needed that flexibility. I really shudder to think if we had been dealing with an HMO in that time.

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#11 of 11 Old 12-04-2009, 11:53 AM
 
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We have had a Cigna PPO for Many years now.
I wish I would have thought to ask for oppinions & advice then.
We were in the same boat last week.
I Let my Hubby decide (its his Employer that provides Ins. & that is changing Ins. companies) And Now I am super worried. It seems the team of Dr.s my SN Daughter has been seeing for 8 years (her whole life) Will be changing. Hubby went with the HMO for financial reasons and I found out yesterday 2 or her Dr.s (Our fam. Ped & her Phycotherapist) NO NOT take HMO at all.

I am awaiting paperwork on the New Ins. CO (Blue Cross: Select) Before I can even figure out what the deal is. But Yeah I'm definatly concerned.
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