PPO vs HMO health coverage?

Question

I need to choose between a PPO and HMO plan at work. They cost about the same. Any ideas of which way to go? The PPO has a $200 deductible and covers 90% of hospital stuff. While the HMO covers 100% and has no deductible, I have to ALWAYS go to a Primary Care Physician first (if I want to then go to a specialist like a dermatologist or allergist, etc). Any thoughts anyone?

PS: The plan is just for me (no dependants or spouse). I'm relatively healthy. I don't travel that much. And I have no doctors currently (relatively healthy + don't like to go to the doctor!). :)

Answer 1

Personally, the $200 deductible is not much of a difference. The 10 percent, however, could end up being a lot of money. Also, your HMO may include more preventive services (routine doctor visits, etc.) in their plans. The access to health care could be important, as you observed, although it might be a good idea to take a look at the HMO roster and see what kind of specialists they have. HMOs are trending toward including dental, vision, and behavioral health specialists in their networks. Just make sure they are the people you’d want to see. I’ve included a link below to a Consumer Reports survey that asked more than 35,000 people how happy they were with their health plans. Also, I’ve included a couple of links that I think are useful in simplifying the process of selecting a health plan.

Hope this helps,
Barnes@MostChoice
http://www.mostchoice.com/health-insurance.cfm

Answer 2

Depends on your needs. Do you travel a lot? PPOs will offer you more options, if God forbid, you get sick away from home. HMOs often direct you to the nearest ER, even for just an earache. Do you need out-of-network benefits? Check and make sure that the doctors you already see and the hospital(s) they're affilated with as well as your local one (if they're not the same) are in-network. Do any members of your family see specialists? Is it possible that somewhere down the road they might? (In other words, is there a condition or disease that runs in your family?)

You basically have to weigh which plan will better address your needs. If you're someone who doesn't use their insurance often, then go with whatever will cost you less.

Good luck!

Answer 3

preferred provider organizations (PPOs) differ from health maintenance organizations (HMOs), in which insureds who do not use participating health care providers receive little or no benefit from their health plan. PPO members will be reimbursed for utilization of non-preferred providers, albeit at a reduced rate which may include higher deductibles, co-payments, lower reimbursement percentages, or a combination of the above.

I use a HMO. I usually do not have any ailments that require me to see a specialist. If are a relatively healthy person who would also not need more that seeing a PCP (primary care provider) you may also benefit from using a HMO

Answer 4

I think a lot depends on the doctor you have. If you get the HMO and you have a wonderful doctor who is on top of things, I would go with the 100% Payout. My current doctor is very quick to send to me to a specialist if she thinks I could benefit. She sent me to a gynecologist, and a otolaryngologist. She also sent my son to a sleep study, where he did have sleep apnea, and then also to a otolaryngologist to have a tonsillectomy. On top of that, his specialist was on the chair of the governors board of health advisors. Make sure you have a good relationship with your primary health provider. You never know what could come up.