Health Insurance - What's better, a PPO or HMO?

[d0ofy]

I just started receiving my health benefits from work, and I have a PPO plan. I know what HMO's are, but what are PPO's? Are PPO's better than HMOs?

 

[The Stigenator]

PPO's are prescription plans, and the best way to describe it is that your doctor makes teh calls not a Insurance Agent.

I have a PPO,and the last time I needed an blood test the doctor called the hospital and said I was coming. I drove in and took the test and the results were back in a day.

The idea of PPO is that you got a family doctor that you choose. ITs a little more for a doctors visit (can vary) but its worth it.

HMO - just the opposite, they have got you by your balls.

 

[Tauren]

HMO's require you pick a primary physician and you have to get a refferal for ANY specialist, etc. With a PPO you can see other specialists at your own choosing. Atleast I think that's how it works. Also, with an HMO you generally have fewer co-pays.

 

[gittyup]

HMO will cost you less for services than PPO in my experience. You have to go with the doctors that participate in the HMO to qualify for a very small co-pay. Otherwise, you will have to pay out of pocket. All of my doctors happen to be on my HMO plan, so I am happy.

 

[Windogg]

PPO it's worth the extra $5 deductible when you are sick as a dog or need a specialist. Getting referrals and crap can be a real pain the butt. Plus you are usually limited to what ever doctors your primary care person knows. This can mean long trips to far off places and inconvenient schedules. With PPO you just start going through people in phonebook or benefits book and pick whoever you want.

Windogg

 

[bcterps]

Well it all depends on how good your PPO or HMO is. In general a PPO gives you the most choice. With an HMO, you MUST be referred by your PCP to see any specialists and you must stay within the HMO network in order for your costs to be covered. The benefits are that you have lower or 0 co-pay.

With a PPO, your co-pay is higher, but you have the option of going out of the network and your insurance company will stay pay most of the costs (usually at least 75%). At least that is the difference between my PPO and HMO.

Usually your premiums for a PPO are slightly higher than an HMO.

--Ben

 

HMOs suck. Stay away from them. If you have the option, always go with the PPO.

 

[Windogg]

I went with PPO because the only difference is that my copay is $15 per visit vs $10 per visit and $10 per prescription vs $5 per prescription. Other than that, all costs are the same. I went with HMO at my last job and it was a nightmare getting scheduled with a specialist. At one point I got fed up and just paid out of pocket which in the end cost more than just going with PPO. Thank god I only stayed with that job for 6 months.

 

[Tauren]

My PCP gives me referrals over the phone. Then just mails the specialist the paper work. It's all in who you go to.

 

[fdiskboy]

I work for a major insurance company.

HMOs have their place, but as far as consumers go, the PPO is a superior product.

 

[Windogg]

My doctor is really good be there are many areas of practice that are short on doctors. I needed to see a dermatologist and with the HMO plan I had about 12 doctors my primary care could give a referral. Turns out that none of them could see me for at least six weeks.

With PPO, I just asked around the office and got opinions from my coworkers. One of them got me an appointment the following day. I'd pay the extra for convenience and my own sanity.

Windogg

 

[JasonG]

I agree with everyone else. Go with the PPO over the HMO unless you really want to limit out of pocket expenses. HMO's can be better for people with families because of the many doctor's visits that kids need. For single people or couples w/o children, PPO's are probably the better option.

It can be a pain to get a your primary doctor to approve every time you want to go to a specialist. If your primary HMO doctor doesn't think you need a specialist, then you really have few options unless you pay for it yourself.

Also, although PPO's pay ~80% for out of network, there is usually a maximum out of pocket expense of ~$1000 over which they will then pay 100%. This means you will never pay more than $1000 out of pocket in a year.

Jason

 

[divinemartyr]

<< HMOs suck. Stay away from them. If you have the option, always go with the PPO. >>



Some people in this forum are badly misinformed and that's unfortunate. Let me explain a couple very special differences to you.

First of all, HMO plans require you to choose a PCP or Primary Care Physician. There is generally a very very large list, especially if you're in a metroplex, of doctors you can go to. Most people *I* know only go to one doctor anyhow, so having to specify one is really not a problem for 95% of people.

Secondly, HMO plans cost about 1/3 out of your paycheck what a PPO will, especially if you're single. If you have a family, it's true that more often than not a PPO will provide you with access to specialists more readily than an HMO plan but for single people who do NOT have major health issues, then HMO is the ONLY way to go.

Think about it this way. HMO plans are generally in the $20/month range for a single person, sometimes less. PPO plans can cost upwards of $60/month for a single person. Most insurance plans will allow you emergency hospital visits at a $50 copay (sometimes $75) with both a PPO AND an HMO plan.

The only REAL difference is with a PPO you can go to almost ANY doctor, specialists included. If your doctor you've been going to for some time is in the HMO network (more than likely if he/she's a pretty good doctor, he/she is) and you don't have major health issues, WHY would you pay more for a PPO plan?

Hospital maximums are also generally the same with PPO and HMO plans (deductible wise).

Prescription copays are generally lower with HMO plans (sometimes they are the same) and office visits with ANY HMO plan are generally $10. With a PPO a lot of times they only cover 80% on office visits and prescription drugs. Imagine having a doctor visit that costs you $200, and having to pay $40 instead of $10.

There are a lot of things to consider about who you are, if you have a family or children or not, and so on. Also your current health state will help determine whether to go with a PPO or an HMO but saying that the PPO is always better, is a very poor statement.

Just to let it be known, I am not saying HMO's are superior either, just stating in many cases there are advantages.

dm

 

[Frenchie]

My ex-employer and I were discussing this issue recently. The PPO option only cost him $5 per month more than the HMO option oer employee. BC/BS was only $10-15 more than the PPO. Needless to say, he went with bc/bs. My last employer gave us the option of a free HMO, PPO with $5 per month deduction, or BC/BS and $20 per month deduction. I went with the PPO and was quite happy. Under normal circumstances (go to PCP), then I paid nothing for a visit. If I went to a non-listed doctor, then I paid 20% just like bc/bs. Same thing about getting pre-approval. A PPO is kind of like merging 60% HMO with 40% BC/BS. Well, at least my plan was.

 

[Missus]

I have a PPO...

 

[vi edit]

I use an HMO simply because I'm in the medical mecca of the midwest (Iowa City). If I had been in a different area that didn't provide me with such a large amount of doctors in one area, I would go PPO.

 

[denali]

Between the two I would choose a PPO however if you can choose and MSA that would be my first choice.

 

[ride525]

How about a POS? How does that compare?

Thanks,