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Health Insurance Care: PPO or HMO better?

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there are ppo and hmo horror stories...the latter leading the charge because 1) they are more common and 2) people not insuring themselves properly then blaming that on a company.

You really can't say a ppo or hmo is better without knowing who takes the plans and what they cover.
 
Originally posted by: alkemyst
there are ppo and hmo horror stories...the latter leading the charge because 1) they are more common and 2) people not insuring themselves properly then blaming that on a company.

You really can't say a ppo or hmo is better without knowing who takes the plans and what they cover.
Click to expand...

Exactly. I've worked places with GREAT HMO plans, covering vision, dental, and health.
 
It depends. The HMO at the hospital I work at doesn't require referrals for specialists, and the prescription plan and co-pays are cheaper. However, since everything with HMOs is co-pay, there's no maximum out-of-pocket...major medical needs (catastrophic accidents, cancer, etc...) can still be prohibitively expensive, even with coverage.

PPOs, OTOH, tend to have annual deductibles, co-insurance, and maximum out-of-pocket. PPOs are traditionally more flexible with coverage (no referrals needed), have larger networks of providers, and cover expenses out-of-state as well. With my HMO, out-of-state treatment requires it be an emergency and treated in the ER, or admitted. No seeing the local urgent care or PCP for the flu when visiting relatives across the country.

Our HMO covers vision and dental, PPO does not. PPO has a better prescription registry (covers more types of drugs, with better allowable amounts/doses).

In my experience, HMOs tend to have lower premiums compared to PPOs.

So yeah, it depends on your needs.

With my current and last employer, the HMOs made more sense for general health care. The costs are generally better, and MUCH better coverage for dental. The PPO would have been the better option if I anticipated getting hit by a car.

Then there's the whole High Deductible PPO + HSA option...I've never gone that route.
 
Matt, why don't you consider BCBS PPO? It'll be more money than BCBS HMO but will be the best of both worlds, especially if you're between multiple states.
 
It's really health network dependent. If the network your HMO is alligned with is a quality group with plenty of primary care and specialists with a decent hospital as the primary care facility then it's a good option.

If you are in an area that has really crappy health care coverage with limited choices then the PPO may give you better options and allow you to choose your care providers better.

I've always been in areas where large and full featured Med Centers were in the HMO plan and I've had no complaints at about having an HMO plan. I'm young and healthy so it's a much cheaper option for me.
 
PPO is actually cheaper for me than HMO and I can pick any doctor or specialist anytime I want without pre-conditions.
I only pay $36/biweeklycheck for that. The company probably subsidizes most of the other cost that's why it's that low.
If I picked the HMO option, it would have been even more expensive with less benefits.
 
Until this year, we went with various HMOs. We switched to a "consumer driven, high deductible" plan (donut plan) this year because the premiums were so much lower than the HMO that even if we filled in the donut hole completely, we would come out ahead. Looks like we picked the wrong year to stop sniffing glue. One trip to the ER filled in the hole and left us with a pretty good ski hill. Good thing there is an annual out-of-pocket limit built into the plan. Now the plan switches to a traditional co-insurance plan with co-payments for drugs. We may still end up ahead of where we would have been with an HMO, we'll have to see how the rest of the year goes.
 
Maybe neither?

Perhaps, goto a doctor that accepts cash payments, and get major catastrophe insurance.

http://www.simplecare.com

Only website I know of where doctors accept cash.

Call around and shop/ask about cash prices or discounts.
 
I do PPO because I have a pre-existing medical condition and want access to specialists without having to go through a primary care doc. Generally speaking I think a PPO provides a more customized level of care. Not something you necessarily need if you're just doing yearly checkups, but quite handy if you think you may need particular treatment.

If the PPO is cheaper, as you hinted, I'd go with that.
 
I had two choices, both HMOs.

My copays for Dr visits are $30, my ER is $100. Perscriptions are $15, $35, $45.

However I have no deductible to meet so all I pay is the co-pays, max a $500 for a hospital visit($100 per day for 5 days). Costs my employer over $400 a month. Costs me $0.
 
I'd go with the PPO. The main con against the HMO is having to get a referral from your primary care physician for special treatment. For example, if you need physical therapy for an injury, with a PPO you just make an appointment for physical therapy and insurance will cover it. With an HMO you have to go to your primary care physician and get a referral for physical therapy. If he/she doesn't think you'll need it, then you're SOL as far as insurance is concerned.
 
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