Here’s the deal,
Eric and I originally had a PPO. Then we switched to an HMO, because it was A LOT cheaper, in that we are currently only paying $15 a month for health insurance.
However, this year, prices went up, and now HMO and PPO will cost about the same monthly (about $130 a month).
This made our decision a little harder in deciding, here are some pros and cons to each:
PPO Pros and Cons
- Con: Expensive. Cost is $136 a month, with $1,000 family deductible, and $9200 out-of-pocket max. We have to pay 20% (not including deductible) for all hospitalizations, surgery, physical therapy, etc.
- Pro: Speed. When Eric had his back injury, we had a PPO and he was able to see a specialist ASAP and receive physical therapy. If we had had an HMO, we would have had to get a referral and wait, wait, wait.
- Pro: Quality. We really liked being able to choose our doctors. I really loved my primary care physician with our old PPO plan.
- Con: Emergency. If Eric had a serious injury (and let’s face it, that is a very real possibility), we would be on the hook for the out-of-pocket max of $9,200.
HMO Pros and Cons
- Pro: Cheap. Cost is $126 a month, with no deductible and $3,000 family out-of-pocket max. No charge for hospitalization, surgery, etc. $15 copay for dr visits.
- Con: Quality. We’re not big fans of the HMO system, the referral system, and the quality of care seems to be lacking a whole bunch in comparison to PPO.
Does it really seem to come down to whether we value money vs. quality of care more?
Eric would prefer to go with PPO, and I am leaning that way too, but being on the hook for $9200 vs $3,000 realllly makes you think. I need to make a decision by Oct. 7 so have at it!
Which do you have and which do you recommend?
12 comments
I would go with the cheaper option if you don’t have any medical issues, but that’s just me. We haven’t really been to the doctor aside from well visits for the past two years.
Hmm, if Kaiser is the HMO, then I say go PPO, however we have an HMO and feel free to email me because I think ours is AWESOME. I don’t feel like we’ve ever had to wait for anything and the referral system is literally a matter of hours (go in for appointment with your doctor in the morning, by afternoon they are calling with the referral and who to call to schedule specialty visit). But, before this we had Kaiser for 3 years, and meh, I think they are just average, way too huge a system to get personal care.
HMO all the way. You can plan all you want but knock on wood, there are crazy medical illnesses that can’t be linked to a job or planning. Surgery, or chemotherapy, or even physical therapy aren’t things you want to have to “think about” based on the price. I’ve never had to wait more than an hour for a referral. Basically if you have a PCP you wouldn’t wait for a referral for anything other than elective plastic surgery.
I’m sure I’m in the minority here, but I loved my HMO and was really bummed when the PPO at my company became hundreds of dollars cheaper per month. I was with Talbert Medical, and never had a problem getting quick referrals when I needed them. Good luck with your decision!
Is the PPO plan HSA compatible?
Here are a couple questions I would ask:
Do you have any planned procedures coming up? How much will they cost you per plan? (a lot of things you can estimate out with your current plan at least)
Does the PPO have co-pays? Are emergency room visits considered hospitalization or is there a separate co-pay on either plan?
Do you see specialists a lot? How is something routine like OB/GYN covered? Do you still need a referral under the HMO?
I’ll agree with what Mysti said and if Eric were to get hurt at work, Worker’s Compensation would cover the medical bills as long as it was covered.
Most of the stuff my husband, daughter, and I use are regular doctors office visits. I have co-insurance rather than co-pays and I miss them SO MUCH. It makes you really think whether you should go to the doctor. With my daughter we don’t hesitate, but with both myself and my husband we’ve let things get worse before they get better because it costs too darn much to just a simple office visit. This year I had my daughter, so it was important to me to be able to choose where and who delivered her, but next year I’m not so picky, and I’d pick a plan where I didn’t pay an arm and a leg!
I used to work in benefits for a Fortune 500, so I geek out about this stuff a little bit. 🙂 It’s a balance of making sure people do the preventative maintenance but don’t have people abuse the care. And now, balancing Obamacare obligations too.
The PPO is $10 per month more and you have to pay your first $1,000 out of pocket for non-preventative care before the insurance company starts paying anything, and it’s a higher out of pocket max. I’d go with the HMO.
I think your sticking point is the out of pocket max. If Eric got hurt on the job, would it be considered worker’s comp? If so, they would be paying for it…not you…so the OOP doesn’t matter. Also, I would look at their maternity coverage. While you aren’t planning on having a family yet (or maybe you are!), those cost can be significant.
In general…I prefer a PPO. We have had one for 15 years and even with all of Bossy’s issues, we have had few problems. But if you are with the HMO currently and are happy with your care….stick with it. You can always switch in a year.
PPO, primarily for the quality of care and to keep my present doctors. The non-Kaiser HMO our firm offers – I could not find a physician accepting new patients any of the three past years I have checked for research purposes. Kaiser would be an acceptable solution, one I am evaluating now with the 24% increase in Anthem premiums versus the 3% jump at Kaiser, but since Obama care is not forcing our plans to be compliant this year, I think I will be putting off the decision until 2015 open enrollment.
I don’t do PPO at my job either for the same reason. Cost. We pay nothing monthly, $5 co pays, no deductibles and no out of pocket cost or hospital cost. The referral thing is not convenient but I’ve had no problem getting urgent care when I needed it and the money I save is worth the hassle. I had a surgery with my HMO and I couldn’t be happier with the care I got. I say go HMO. Unless you have some kind of medical condition and/or really feel you are not receiving proper care with HMO I see no reason to switch.
Comes down to cost for me. I wouldn’t go with the PPO plan (I’ve had both, and liked PPO better) unless I had the full out-of-pocket max in savings. That’s a big difference – especially with no deductible on the HMO plan.
PPO! Definitely PPO! If you have a real medical problem, (and as you know I’ve had my fair share), you do NOT want to wait around to see one doctor in order to receive a referral to another. You want good, quality healthcare as soon as you can get it. The HMO system is cheaper but the loopholes you must step through in order to actually seek care do not make the cost worth it. In my personal opinion very few things in life are more important than your health. Given Eric’s line of work and the fact that something could go wrong you do not want to get caught up in the never ending waiting game for doctors. It can take a lot of time to see specialists as it is. You don’t want to have to wait around for an appointment with your primary doctor so you can get an appointment with the doctor you really need to see. Usually the costs for a PPO are two to three times higher than an HMO. That’s the case for us. (My husband is self employed.) If the month to month difference isn’t that great then I suggest choosing the PPO. You two save a ton of money and could easily set aside funds to cover the out-of-pocket max. If Eric really got hurt you wouldn’t blink at spending $9,200 to help him quickly. Take my two cents with a grain of salt. I’ve been through a lot of medical stuff throughout the last ten years, but having said that I’m glad I’ve never been sent through the referral madness of an HMO! Doctors are frustrating enough without that added hassle.