Just a quick one understanding if people have had any good or bad experiences with HMO vs PPO?

Our company offers PPO as standard but they also offer a scheme where if you find your own health insurance they will substitute the difference into your pay, the saving from PPO to HMO seems quite significant so its certainly something we're considering but as we will be new into the US health system (which seems like a minefield from the outside) we just wanted to see if any people had any opinions, advice or comments,

Appreciate any responses,

I would advise you take the standard option for your first year (at least). There will be a LOT for you to learn about US health insurance, and I wouldn't bother trying to save money on plans until you have found your feet.

There is a lot more to it tha PPO/HMO, in particular, what doctors/facilities will be "in network". All else being equal (which it isn't), I have personally found HMOs to be enough of a pain that I am happy to pay more for a PPO.

An HMO requires you to get approval for all medical procedures requiring a specialist through your GP who acts as the insurance company filter. Kind of like the NHS. The problem - depending where you live - is (a) finding a good GP (all the good ones I've had have retired and the next generation isn't replacing them in sufficient numbers) and (b) getting a timely appointment. A PPO allows you to go straight to a specialist without GP referral. I've had both and the PPO is much better and worth the money in my opinion.

An HMO will be fine if you only need standard checkups, preventative care and the odd doctor visit for a minor illness. A PPO will cost more in premiums (and deductibles if you choose an out of network provider) but if faced with a serious emergent health situation you will appreciate the ability to select your own doctors. I have had both and would always select a PPO if available.

This!! I remember two occasions where the PCP referral added a month to getting specialist treatment. And we're not talking very "specialist": a podiatrist and dermatologist.

if that extra pay comes as W2 income it will be taxed at the highest rate. If you go that route you should look at a HDHP with the difference going in to a HSA…

when you compare plans you need to model 3 scenarios to see what it would cost you with each:
- preventative care only
- a moderate claim like when my son needed ear tubes
- and a worst case type scenario where you end up in an ICU for weeks or cancer treatment..

when you look at the cost look at the total of employer paid premiums and what you pay, because if you ever need Cobra you pay 102%, although with the ACA that can also work out cheaper even without a subsidy…

also note that when you pay the premiums they are not tax deductible if you receive W2 pay, but are if you are “self employed” i.e. 1099 income…

The HMO vs PPO may also depend on where you live. I have lived in both CA and WA, both in major cities, and have found Kaiser HMO to be a great option for my family. Just last night I was having an MRI which was scheduled promptly - I don't experience any delays for treatment. The advantages are that I pay a token amount to see the doctor/specialist and then never see a bill, no matter what is needed. It is very simple and integrated.

If I lived far from their offices my experience would be very different, but in the last 10+ years I have never regretted going the HMO route.