HMO or PPO?
 

Hi all!

I did a little searching in the forums but did not get the answers I was really looking for.

It looks like I may be switching companies in the very near future. Right now my medical insurance is through the Union and is more a medical fund, with one big pot everyone pays into. It is a PPO setup so no need for referrals etc. I have never had to pick plans before because of this, My new employer offers two options, a PPO and a HMO. Both are through Cigna it appears. The PPO has a lower monthly premium (only by about $20) but a higher out of pocket maximum ($3700/$7400 vs $2400/$4800). We are looking to hopefully start trying for another baby in the near future so, due to this the HMO seems like it would be the better option? I gather HMO's are far more limiting and this is what has me concerned. I am about to start checking to see if our present doctors accept this HMO plan, if so I will probably go this route. Does anyone have any insight as to the for or against for each?

I hate that this is all so complicated and confusing here!

Re: HMO or PPO?
 

I would never (never say never) do an HMO. I want the option to be able to choose to go where I want when I want. Our neighbors have Group Health (although the husband calls it Group Death) and they've had numerous problems.

Re: HMO or PPO?
 

This is the reason I am questioning going with the HMO option. I like choice too! All completely new to me though!

Re: HMO or PPO?
 

I suppose with an HMO you have the luxury of paying just a co-pay to see the doctor, right? Or have things changed there?

We also have Cigna, but our only option was the PPO. Even though our deductible is fairly high ($2500) we do have an HSA attached and my husband's employer contributes to that (as does my husband) so that doctor appointments, prescriptions, etc come out of that fund.

Re: HMO or PPO?
 

It appears that the co-pays are the same on each plan for in-network outpatient Services (Primary Care Provider), Specialist Office Visit, Preventative Care, Urgent Care and ER?

Our co-insurance is 10% difference in favor of the HMO

Re: HMO or PPO?
 

What about out-of-network? Is the PPO nationwide for in-network? What if you are out of your area on the HMO?

Re: HMO or PPO?
 

Have a look around the local area you're in and see how many healthcare providers are in network for Cigna.

I have an HMO with United Healthcare, but almost every doctor's office and hospital in our local area is in the United Healthcare network, so not an issue, I have literally hundreds of doctors offices to choose from. So in that sense it made sense for us, as the co-pays were less and the premiums were a little less expensive.

If we go on holiday somewhere (not likely this year, we're not made of money) I'd spend a lot of the time worrying that if something did happen, we'd be using an out-of-network provider and paying through the neck as a result.

Re: HMO or PPO?
 

I am assuming so, as my employer is based (HQ) in a different state to me? I will make a call and verify I guess. There is a list of providers online I will check also.

As for the HMO, no coverage amounts are listed there, so I am presuming I am on my own if I cannot find anyone in network while out of town?

Re: HMO or PPO?
 

It appears to be the same here, a lot of our existing doctors are in-network. I also have the concerns if i were to travel anywhere.

What I would give for a single payer system!! No need for all this BS!!

Re: HMO or PPO?
 

Hush now, that's socialism. :frown:

Re: HMO or PPO?
 

It's also Medicare but some people chose a HMO through "Medicare Advantage" because they prefer being billed by private insurance companies than the government.

Re: HMO or PPO?
 

Depends on the plan and location.

If you don't have much choice for doctors and hospitals, it might not be as good, but if you're in a city, it probably won't make much difference.

Sure, you'll need a referral for stuff, but if your doctor isn't a arse, it won't be a problem.

If I need a referral I can just ring my doctor and they'll fax one to who I want to see and the insurance company so there's no actual visit/co-pay.

It's not been any different to the old PPO.

Also apart from co-pay, no up front costs.

Edit: To add, for us, there's a option on network, the cheap one is limited to local vicinity for in-network. There's a option for state/region wide network or nationwide/international network.

Re: HMO or PPO?
 

PPO: gives more choice but one can spend a lot of time dealing with claims etc. I found the hassle factor to be quite a burden.

HMO: much easier but less choice. However, that doesn't mean no-choice. The better HMO's have very large networks and can be reasonably accommodating with your preferences.

We have the choice of plans and have remained with the HMO option. We're pretty satisfied, at least with our provider/network.

Of course, neither system is perfect and you'll find horror stories from HMO members as well as PPO members.

Re: HMO or PPO?
 

We didn't find that to be the case with our options. Same hospitals, same doctors.

Only difference was with PPO, you could go straight off and then had to deal with claims whilst with the HMO, you had to ring your PCP first to get a referral.

Re: HMO or PPO?
 

Ok, it looks like the HMO might be the better option. The co-insurance is 10% less, so if something major were to happen my exposure is limited, plus the out-of-pocket is a lot less. All our current physicians are all in network, so no issues there. As far as being out of town / travelling and something happens I was told as long as I contact my primary care physician within 24 hrs it will also be covered even though out of network.

Does this sound right?
This is coming from their (prospective employer) HR department.