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HMO vs PPO

C

CtK

Diamond Member
Boss is gonna start paying for my health insurance so I need to decide which is best
i was quoted from BlueCross BlueShield:

HMO- $135 a month
PPO- $143 a month with $500 deductible

any info will be very helpful
thanks!!
 
PPO is my preference--more freedom, more flexibility, much less hassle needed for specialty care! Your choice will depend on your needs. If you very seldom require healthcare, go with cheaper HMO.
 
Originally posted by: Mermaidman
PPO is my preference--more freedom, more flexibility, much less hassle needed for specialty care! Your choice will depend on your needs. If you very seldom require healthcare, go with cheaper HMO.
Click to expand...

thanks for the reply
but i think i will need to get my knees looked at
they hurt like crazy!!
 
The whole point of health insurance, for me, is the max yearly deductible. PPOs, generally, have co-pays for hospitalization of 20% which can easily become an astonomical figure.
 
I have HMO through KP. No deductible, $20 copay, $500 per admission to hospital, no lifetime max, and $15 prescriptions for $141/month at 30yo. They have an extensive network here and I haven't had any of the stereotypical HMO problems. I can pick my doc and specialist and change them when I wish. I chose them over BCBS. Not available in your area though. I think the kinks have been worked out of the HMO thing.
 
can someone with PPO give me an example about the 20% co pay and the $500 deductible
thanks!!
 
Originally posted by: CtK
can someone with PPO give me an example about the 20% co pay and the $500 deductible
thanks!!
Click to expand...
As you know, these numbers will vary. My company offers two levels of PPO coverage. I chose the cheaper premium option. THere is a $25 copay per visit. The deductible is $350 for in-network and $1250 for non-network. Coverage is 80% in-network and 50% non-network.
 
The Fatitudes! (In the Beginning)
>
> In the beginning...God covered the earth with broccoli, cauliflower,
> and spinach, with green and yellow and red vegetables of all kinds, so
> Man and Woman would live long and healthy lives.
>
> Then using God's bountiful gifts, Satan created Ben and Jerry's and
> Krispy Kreme.
>
> And Satan said: "You want hot fudge with that?"
>
> And Man said: "Yes!"
>
> And Woman said: "I'll have one too...with sprinkles."
>
> And lo, they gained 10 pounds.
>
> And God created the healthful yogurt that Woman might keep the figure
> that Man found so fair.
>
> And Satan brought forth white flour from the wheat, and sugar from
> the cane, and combined them.
>
> And Woman went from size 2 to size 14.
>
> So God said: "Try my fresh green garden salad."
>
> And Satan presented crumbled Bleu Cheese dressing and garlic toast
> on the side.
>
> And Man and Woman unfastened their belts following the repast.
>
> God then said: "I have sent you heart healthy vegetables and olive
> oil in which to cook them."
>
> And Satan brought forth deep-fried coconut shrimp, butter-dipped
> lobster chunks, and chicken-fried steak--so big it needed its own
> platter.
>
> And Man's cholesterol went through the roof.
>
> Then God brought forth the potato, naturally low in fat and brimming
> with potassium and good nutrition.
>
> Then Satan peeled off the healthful skin and sliced the starchy
> center into chips and deep-fried them in animal fats adding copious
> quan! tities o f salt.
>
> And Man put on more pounds.
>
> God then brought forth running shoes so that his Children might lose
> those extra pounds.
>
> And Satan came forth with a cable TV with remote control so Man would
> not have to toil changing the channels.
>
> And Man and Woman laughed and cried before the flickering light and
> started wearing stretch jogging suits.
>
> God then gave lean beef so that Man might consume fewer calories and
> still satisfy his appetite.
>
> And Satan created McDonald's and the 99-cent double cheeseburger.
>
> Then Satan said: "You want fries with that?"
>
> And Man replied: "Yes! And super size 'em!"
>
> And Satan said: "It is good."
>
> And Man and Woman went into cardiac arrest.
> God sighed...and created quadruple by-pass surgery.
>
> And then...Satan chuckled and created HMOs
 
I have a PPO with a 600 decductable. What that means is that anytime you see a doctor, you will pay for it until you reach that 600 dollars. For instance, if you see the doctor twice, and the totals were 500, you would pay that 500 out of pocket. If you have a total of 3 office visits which cost 750, then you will pay $600 and the ppo will pay 150.
 
i got HMO they said with PPO the most i will pay is $3500 a year and then they cover the rest
but with HMO the most i will pay is $1500 a year and then they will cover the rest
and my family dr is on the HMO list
 
avoid HMO at all costs. even if a PPO is twice the price.

If there are any medical professionals on this board I'm sure they would agree.

biggest problem is they send you to whatever doctor is the cheapest - and you generally get what you pay for.
 
HMO is only good till you have an emergency. Then you'll have to wait till you get a hold of your doctor and get his opinion before going to the emergency room or risk the chance of paying for the visit yourself. With PPO, you get to make the decision whether or not its an emergency and you'd be covered no matter what.

So you just have to ask yourself, am I smart enough to determine when I need emergency care?

Answer:
Yes = PPO
NO = HMO.

😉

Its cheaper with HMO because in times of emergencies, ( the more costly times) you may end up paying for it yourself. That's the risk you take.
 
Originally posted by: HeroOfPellinor
The whole point of health insurance, for me, is the max yearly deductible. PPOs, generally, have co-pays for hospitalization of 20% which can easily become an astonomical figure.
Click to expand...

Affirmative. PPO are handy if you want to pick and choose your doctos, but that 80% crap is likely to leave you pretty screwed if something serious happens to you. PPO would be ideal even with that deductable if it covered 100%. Assuming it does not, get the HMO. 20% of a whole freaking lot of money is still a whole freaking lot of money.
 
Originally posted by: cjchaps
I have a PPO with a 600 decductable. What that means is that anytime you see a doctor, you will pay for it until you reach that 600 dollars. For instance, if you see the doctor twice, and the totals were 500, you would pay that 500 out of pocket. If you have a total of 3 office visits which cost 750, then you will pay $600 and the ppo will pay 150.
Click to expand...

Sure...that's fine for doctor visits...but what about hospitalization? You have to pay 20%. Check the average for even light surgeries, divide that number by 10 then times by 2 and that's what you will have to write a check for. Unless there are max yearly deductible PPOs.
 
Originally posted by: spidey07
avoid HMO at all costs. even if a PPO is twice the price.

If there are any medical professionals on this board I'm sure they would agree.

biggest problem is they send you to whatever doctor is the cheapest - and you generally get what you pay for.
Click to expand...

i'm a health pre-professional and i'll say that while HMOs get the bad rap, they're not as bad as you might think. one advantage is that they provide preventative services, meaning most HMOs advise you when to get immunizations, checkups, etc. why? so you're in better health and avoid disease so that it's cheaper for them to maintain you and your family as members.

PPOs do give the most freedom of choice, but there is something called perverse incentive--doctors bill the insurance for each service rendered so they have a 'perverse incentive' to give you more services than you may need. why? to maximize their profits 😉

with that said, to the OP, see if your company offers POS--point of service. you get the best of both worlds (HMO + PPO). on one hand, you are assigned a primary care doctor. however, if you ever want to see another doctor, you have that freedom. like an 'escape hatch'. you will pay a bit more for going out of network, but you have that freedom--something everybody seems to want.

cliff notes: HMO not as evil as everybody portrays. PPO gives max freedom, but does have its drawbacks. see if company offers POS plan.
 
Originally posted by: cheapbidder01
HMO is only good till you have an emergency. Then you'll have to wait till you get a hold of your doctor and get his opinion before going to the emergency room or risk the chance of paying for the visit yourself. With PPO, you get to make the decision whether or not its an emergency and you'd be covered no matter what.

So you just have to ask yourself, am I smart enough to determine when I need emergency care?

Answer:
Yes = PPO
NO = HMO.

😉

Its cheaper with HMO because in times of emergencies, ( the more costly times) you may end up paying for it yourself. That's the risk you take.
Click to expand...

Seeing how my dermatologist allows me to get referals from my primary care doctor after I have visited her, I don't think I would likely have to wait on the way into an ER. But your plan may be different.
 
PPO is good in case you have to consult a specialist (doctor) and he or she doesn't except HMO plans but other than that HMO is good. HMO puts your thry some hastle as far as getting refferals are concerned but most doctors offices do it over the phone.

In case of HMO you might not have to pay for MRI or blood work or any other lab tests where as for PPO you will have to pay since you have a deductible. Most PPO's have 2 level deductible, when you reach leavel 1 decutible limit they will pay up to 80% and then 100% when you reach the 2nd level limit.

But make sure you read the papers carefully.

I picked HMO for mine even though we have to pay more for HMO than PPO :Q
 
Originally posted by: PingSpike
Originally posted by: HeroOfPellinor
The whole point of health insurance, for me, is the max yearly deductible. PPOs, generally, have co-pays for hospitalization of 20% which can easily become an astonomical figure.
Click to expand...

Affirmative. PPO are handy if you want to pick and choose your doctos, but that 80% crap is likely to leave you pretty screwed if something serious happens to you. PPO would be ideal even with that deductable if it covered 100%. Assuming it does not, get the HMO. 20% of a whole freaking lot of money is still a whole freaking lot of money.
Click to expand...

that's what the out of pocket maximum is for. You can't go over a certain amount per year no matter what.
 
Originally posted by: spidey07
Originally posted by: PingSpike
Originally posted by: HeroOfPellinor
The whole point of health insurance, for me, is the max yearly deductible. PPOs, generally, have co-pays for hospitalization of 20% which can easily become an astonomical figure.
Click to expand...

Affirmative. PPO are handy if you want to pick and choose your doctos, but that 80% crap is likely to leave you pretty screwed if something serious happens to you. PPO would be ideal even with that deductable if it covered 100%. Assuming it does not, get the HMO. 20% of a whole freaking lot of money is still a whole freaking lot of money.
Click to expand...

that's what the out of pocket maximum is for. You can't go over a certain amount per year no matter what.
Click to expand...

Huh, did not know that. What are standard out of pocket maximum rates?
 
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