Author Topic: Employer Healthcare - HMO vs PPO  (Read 2209 times)

Truckman

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Employer Healthcare - HMO vs PPO
« on: November 11, 2013, 01:14:33 PM »
I have several different options available to me for healthcare: an HMO (3 different options), a Standard PPO (3 different options), and a High PPO (also 3 different options). We are currently under one of the High PPO options which we are currently paying $180/pay (26 pays). To stay on that same plan it's going up to $202/pay. It really is a cadillac of plans, after having read a bunch of MMM over the last month or so, I'm really questioning our need to spend that much.  The Standard PPO is pretty much an 80/20 plan, where we would be responsible for 20% of the bill with a $500 deductible (for the family). The Standard PPO plan runs in the ballpark of $135/pay.

Then there's the HMO plans, which come in at around $55/pay. Quite a bit of savings potential here. I'm just really concerned about the trade-offs. On the surface, it seems to be an even better deal - the kids' pediatrician accepts it, the co-pays for standard office visits are $5 (vs $10 for the High plan and $25 for the Standard). But I have 2 teenage girls involved in sports year-round, have already had some broken bones and dislocations to deal with, and I'm concerned about the level of care offered by HMO's in general. I know I need to investigate this plan a bit further in detail, but I guess I'm just looking for some general guidance or opinions on HMO's.  Wife and I are in general OK health, although we're pushing the limit and need to get ourselves on track with better eating and exercise.

AFAIK, none of our options allow for HSA access, nor high-deductible type plans that seem to be favored by MMM himself.  Personally, I'm mostly ready to make the leap, but the Mrs. buys into the fear and will be a tough sell....

frugaldrummer

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Re: Employer Healthcare - HMO vs PPO
« Reply #1 on: November 11, 2013, 05:05:08 PM »
It's important to distinguish between different kinds of HMOs.

Is it a paper HMO, which is just a financial arrangement between doctors and insurance?  In which case, there may be disincentives applied to the doctors (i.e. if you send to many ankle sprains to the orthopedist you lose money).  Plus if you accidentally get referred to a specialist outside the plan, you could be hit with a big bill.

On the other hand, a staff-model HMO like Kaiser, where all the docs work directly for the organization and only for the organization, can be a really good deal. You know automatically that any doctor there is on your plan.  And from experience (my ex is a gyn surgeon there) there is no insurance company calling up the doctor asking why Mrs. A hasn't been discharged yet.  You would be limited to the specialists they have on staff, but depending on your city, that may not be a bad thing (we live in a very desirable city and the quality of docs at Kaiser is good - my ex, for example, is one of the top ten in his field in the country - but chose Kaiser because of goods hours and this desirable city).

If you really like your current doctors, I'd go for the standard PPO, unless you go often to the doctor.

Truckman

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Re: Employer Healthcare - HMO vs PPO
« Reply #2 on: November 12, 2013, 05:41:18 AM »
OK, thanks for the info. It's the Aetna Standard HMO, if that helps. Unfortunately Kaiser is not located within a reasonable distance from me although it is offered as an option. But a 45 minute one-way drive to the nearest facility kind of rules them out.  The Aetna HMO seems to be accepted by the kids' pediatrician, and also the local orthopedic center and local hospitals. But it seems that there isn't an Aetna facility like there is a Kaiser facility, so I assume it's the paper-type that you warned about. Also, our personal physician doesn't accept it. I'm not opposed to finding a new doc, but my wife doesn't really want to.  We don't go to the doctor often, generally only for the raging sinus infections that crop up several times each winter. No daily maintenance type meds or health conditions.