What are some benefits comparing a PPO an an HMO?

Question

Open enrollment is coming up and my wife and i are trying to decide what to go with for health insurance-- a PPO or an HMO.

Does anyone have any positive or negative things to say about either one?

It is just the 2 of us with no kids.

Thanks in advance for any info.

Answer 1

I would suggest you go for HMO.

with my personal experience i find HMO the best.

iniitially i used to have PPO. but in that I had to pay the deductible & also the coverage was just 80%. I had to pay 20% of the cost.

so it was not total coverage.

then the company had to change its insurance & they provided Aetna HMO. & i wud say it was the best ever we had.

I got pregnant and it had good pregnancy benefits.
my pregnancy, delivery & after delivery all was taken care by HMO.

i didnt had to shell out a single penny. Tthe hosptital charges for my delivery showed around $11,000. but i didnt pay anything for that. everything was taken care by the insurance.

but now again my insurance has changed & i am paying a lot for it now.

so i wud recommend u go for HMO. it has a good coverage of doctors, specialists & hospitals.
so nothing to worry abt that.

Answer 2

You usually get better coverage with a PPO, but remember that when you go PPO the number of doctors/specialists you can choose from is less than what you'll find with an HMO. PPO stands for "preferred provider organization," so only certain doctors who meet the criteria provide services for a PPO. But again, if your doctor is on the PPO list or you're willing to transfer to another doctor who is part of the PPO, you'll usually have less out-of-pocket expenses with a PPO.

Answer 3

It depends: Do you travel a lot within the US? Do you see a number of specialists?

PPOs are better in that case because then you don't need a referral to see a doctor (either out of your area or just a specialist.) HMOs require referrals for everything.

On the flip side - HMOs generally don't have any out of pocket expenses aside from your copay... As long as you use a participating doctor and have referrals. PPOs sometimes have deductibles and co-insurance (which is a formula they use to determine your percentage of payment... Often 20% - but they calculate it from the contracted rate they've pre-negotiated with the provider. If you have a deductible & co-insurance, NEVER let them bill you up front - have them bill the insurance first, and the insurance will tell them what amount to charge you.) BUT, if you travel or if you see any specialists, they can beneficial - because you often have the ability to go out of network - you may pay a little more on the deductible and a higher percentage of co-insurance, but it might be worth it, especially if the network is limited in your area. (For example, I work in Rockland County, NY - there's a PPO plan of insurance based in NYC, and the further outside of the five boroughs you go, your choices are limited - much more north of me, you're hard-pressed to find a doctor who's in network, but they let you go out of network if you need to.) HMOs discourage that.

Answer 4

with a PPO you have more choices; you can usually choose between a number of in network doctors/providers; PPO usually costs more, but it has been my experience that it is worth the difference; check with your Human Resources Department; they should be able to give you more detailed comparisons for your particular insurance

Answer 5

look at the cost per visit and perscription price then condier your option with in if its for a family or what