HMO or PPO

T

Tumbleweed

New member
Hey guys. I'm sorry if this has been posted before...

So my husband is possibly switching jobs soon and we will have the choice to pick an HMO or PPO insurance plan. I know most of the general public prefers PPO because you can "self refer" and don't have to see a primary care physician first.

But I have heard that the co-pays and share of cost is higher with PPO, and of course all the bills for all my meds (TOBI,COLI etc.) are astronomical so paying 20% every month or whatever is out of the question.
I don't know what the total out of pocket maximum is for either plan, either.

Oh yeah, I have medicare through disability, and don't know if they would pick up the tab for the rest.

Anyway, I was wondering if any of you have had to choose before between HMO or PPO, and which one has worked out better for you. Obviously I don't want to jump through a million hoops, but don't want to (& can't) afford to pay high co-pays as well.
Thanks!
 
T

Tumbleweed

New member
Hey guys. I'm sorry if this has been posted before...

So my husband is possibly switching jobs soon and we will have the choice to pick an HMO or PPO insurance plan. I know most of the general public prefers PPO because you can "self refer" and don't have to see a primary care physician first.

But I have heard that the co-pays and share of cost is higher with PPO, and of course all the bills for all my meds (TOBI,COLI etc.) are astronomical so paying 20% every month or whatever is out of the question.
I don't know what the total out of pocket maximum is for either plan, either.

Oh yeah, I have medicare through disability, and don't know if they would pick up the tab for the rest.

Anyway, I was wondering if any of you have had to choose before between HMO or PPO, and which one has worked out better for you. Obviously I don't want to jump through a million hoops, but don't want to (& can't) afford to pay high co-pays as well.
Thanks!
 
T

Tumbleweed

New member
Hey guys. I'm sorry if this has been posted before...

So my husband is possibly switching jobs soon and we will have the choice to pick an HMO or PPO insurance plan. I know most of the general public prefers PPO because you can "self refer" and don't have to see a primary care physician first.

But I have heard that the co-pays and share of cost is higher with PPO, and of course all the bills for all my meds (TOBI,COLI etc.) are astronomical so paying 20% every month or whatever is out of the question.
I don't know what the total out of pocket maximum is for either plan, either.

Oh yeah, I have medicare through disability, and don't know if they would pick up the tab for the rest.

Anyway, I was wondering if any of you have had to choose before between HMO or PPO, and which one has worked out better for you. Obviously I don't want to jump through a million hoops, but don't want to (& can't) afford to pay high co-pays as well.
Thanks!
 
T

Tumbleweed

New member
Hey guys. I'm sorry if this has been posted before...

So my husband is possibly switching jobs soon and we will have the choice to pick an HMO or PPO insurance plan. I know most of the general public prefers PPO because you can "self refer" and don't have to see a primary care physician first.

But I have heard that the co-pays and share of cost is higher with PPO, and of course all the bills for all my meds (TOBI,COLI etc.) are astronomical so paying 20% every month or whatever is out of the question.
I don't know what the total out of pocket maximum is for either plan, either.

Oh yeah, I have medicare through disability, and don't know if they would pick up the tab for the rest.

Anyway, I was wondering if any of you have had to choose before between HMO or PPO, and which one has worked out better for you. Obviously I don't want to jump through a million hoops, but don't want to (& can't) afford to pay high co-pays as well.
Thanks!
 
T

Tumbleweed

New member
Hey guys. I'm sorry if this has been posted before...
<br />
<br />So my husband is possibly switching jobs soon and we will have the choice to pick an HMO or PPO insurance plan. I know most of the general public prefers PPO because you can "self refer" and don't have to see a primary care physician first.
<br />
<br />But I have heard that the co-pays and share of cost is higher with PPO, and of course all the bills for all my meds (TOBI,COLI etc.) are astronomical so paying 20% every month or whatever is out of the question.
<br />I don't know what the total out of pocket maximum is for either plan, either.
<br />
<br />Oh yeah, I have medicare through disability, and don't know if they would pick up the tab for the rest.
<br />
<br />Anyway, I was wondering if any of you have had to choose before between HMO or PPO, and which one has worked out better for you. Obviously I don't want to jump through a million hoops, but don't want to (& can't) afford to pay high co-pays as well.
<br />Thanks!
<br />
<br />
<br />
<br />
<br />
 
L

lightNlife

New member
I vote for the HMO. Having more meds covered and having smaller copays is key. Also, some PPOs don't cover durable medical (home infusion).

Here's an article I wrote about navigating an HMO:

<a target=_blank class=ftalternatingbarlinklarge href="http://www.associatedcontent.com/article/81541/guide_to_navigating_a_hmo_as_a_person.html?cat=5">http://www.associatedcontent.c...as_a_person.html?cat=5</a>
 
L

lightNlife

New member
I vote for the HMO. Having more meds covered and having smaller copays is key. Also, some PPOs don't cover durable medical (home infusion).

Here's an article I wrote about navigating an HMO:

<a target=_blank class=ftalternatingbarlinklarge href="http://www.associatedcontent.com/article/81541/guide_to_navigating_a_hmo_as_a_person.html?cat=5">http://www.associatedcontent.c...as_a_person.html?cat=5</a>
 
L

lightNlife

New member
I vote for the HMO. Having more meds covered and having smaller copays is key. Also, some PPOs don't cover durable medical (home infusion).

Here's an article I wrote about navigating an HMO:

<a target=_blank class=ftalternatingbarlinklarge href="http://www.associatedcontent.com/article/81541/guide_to_navigating_a_hmo_as_a_person.html?cat=5">http://www.associatedcontent.c...as_a_person.html?cat=5</a>
 
L

lightNlife

New member
I vote for the HMO. Having more meds covered and having smaller copays is key. Also, some PPOs don't cover durable medical (home infusion).

Here's an article I wrote about navigating an HMO:

<a target=_blank class=ftalternatingbarlinklarge href="http://www.associatedcontent.com/article/81541/guide_to_navigating_a_hmo_as_a_person.html?cat=5">http://www.associatedcontent.c...as_a_person.html?cat=5</a>
 
L

lightNlife

New member
I vote for the HMO. Having more meds covered and having smaller copays is key. Also, some PPOs don't cover durable medical (home infusion).
<br />
<br />Here's an article I wrote about navigating an HMO:
<br />
<br /><a target=_blank class=ftalternatingbarlinklarge href="http://www.associatedcontent.com/article/81541/guide_to_navigating_a_hmo_as_a_person.html?cat=5">http://www.associatedcontent.c...as_a_person.html?cat=5</a>
 
A

Allisa35

Member
I would say HMO also. Can you get a copy of what each plan pays so you can compare which would be better for you. We chose the HMO for several reasons:

1. My CF doc is in the network as well as my PCP.
2. With the HMO we have no deductible as opposed to the PPO which is $3,000 per year and then there is an out-of-network deductible of $6,000 per year.
3. The out-of-pocket for the HMO is $3,000 and for the PPO it is $4,500.
4. Both plans pay 80% for most items and 100% for dr. visits after the co-pay which is $20 for my CF doc and $15 for my PCP (PPO is $20 for each dr.)
5. There is no lifetime max with the HMO whereas the PPO is (combined)$5,000,000.
6. Both plans pay the same for meds.

The premium would cost less if we chose the PPO, but in the long run, the HMO was more suitable. I used to have to get a referral every time I needed to see my CF doc, but he's now a part of some special thing (I forget what they call it) and I don't have to do that anymore.

Good luck!
 
A

Allisa35

Member
I would say HMO also. Can you get a copy of what each plan pays so you can compare which would be better for you. We chose the HMO for several reasons:

1. My CF doc is in the network as well as my PCP.
2. With the HMO we have no deductible as opposed to the PPO which is $3,000 per year and then there is an out-of-network deductible of $6,000 per year.
3. The out-of-pocket for the HMO is $3,000 and for the PPO it is $4,500.
4. Both plans pay 80% for most items and 100% for dr. visits after the co-pay which is $20 for my CF doc and $15 for my PCP (PPO is $20 for each dr.)
5. There is no lifetime max with the HMO whereas the PPO is (combined)$5,000,000.
6. Both plans pay the same for meds.

The premium would cost less if we chose the PPO, but in the long run, the HMO was more suitable. I used to have to get a referral every time I needed to see my CF doc, but he's now a part of some special thing (I forget what they call it) and I don't have to do that anymore.

Good luck!
 
A

Allisa35

Member
I would say HMO also. Can you get a copy of what each plan pays so you can compare which would be better for you. We chose the HMO for several reasons:

1. My CF doc is in the network as well as my PCP.
2. With the HMO we have no deductible as opposed to the PPO which is $3,000 per year and then there is an out-of-network deductible of $6,000 per year.
3. The out-of-pocket for the HMO is $3,000 and for the PPO it is $4,500.
4. Both plans pay 80% for most items and 100% for dr. visits after the co-pay which is $20 for my CF doc and $15 for my PCP (PPO is $20 for each dr.)
5. There is no lifetime max with the HMO whereas the PPO is (combined)$5,000,000.
6. Both plans pay the same for meds.

The premium would cost less if we chose the PPO, but in the long run, the HMO was more suitable. I used to have to get a referral every time I needed to see my CF doc, but he's now a part of some special thing (I forget what they call it) and I don't have to do that anymore.

Good luck!
 
A

Allisa35

Member
I would say HMO also. Can you get a copy of what each plan pays so you can compare which would be better for you. We chose the HMO for several reasons:

1. My CF doc is in the network as well as my PCP.
2. With the HMO we have no deductible as opposed to the PPO which is $3,000 per year and then there is an out-of-network deductible of $6,000 per year.
3. The out-of-pocket for the HMO is $3,000 and for the PPO it is $4,500.
4. Both plans pay 80% for most items and 100% for dr. visits after the co-pay which is $20 for my CF doc and $15 for my PCP (PPO is $20 for each dr.)
5. There is no lifetime max with the HMO whereas the PPO is (combined)$5,000,000.
6. Both plans pay the same for meds.

The premium would cost less if we chose the PPO, but in the long run, the HMO was more suitable. I used to have to get a referral every time I needed to see my CF doc, but he's now a part of some special thing (I forget what they call it) and I don't have to do that anymore.

Good luck!
 
A

Allisa35

Member
I would say HMO also. Can you get a copy of what each plan pays so you can compare which would be better for you. We chose the HMO for several reasons:
<br />
<br />1. My CF doc is in the network as well as my PCP.
<br />2. With the HMO we have no deductible as opposed to the PPO which is $3,000 per year and then there is an out-of-network deductible of $6,000 per year.
<br />3. The out-of-pocket for the HMO is $3,000 and for the PPO it is $4,500.
<br />4. Both plans pay 80% for most items and 100% for dr. visits after the co-pay which is $20 for my CF doc and $15 for my PCP (PPO is $20 for each dr.)
<br />5. There is no lifetime max with the HMO whereas the PPO is (combined)$5,000,000.
<br />6. Both plans pay the same for meds.
<br />
<br />The premium would cost less if we chose the PPO, but in the long run, the HMO was more suitable. I used to have to get a referral every time I needed to see my CF doc, but he's now a part of some special thing (I forget what they call it) and I don't have to do that anymore.
<br />
<br />Good luck!
 
S

Skye

New member
I would call the plan administrator and find out some of the answers to your questions. We have a PPO and I much prefer that. No pre-authorizations and no small network. There is no lifetime max on my PPO. A small co-pay to pay for doctor's visits, copays with meds that are affordable (not 80/20), and I have the option of going out of network if I ever need to and paying that 80/20 for the visit. I had an HMO in FL and found it very constraining. That was about 10 years ago though and maybe things have changed. I say write down some questions and make some calls: what is the lifetime max on both plans, what are the co-pays for meds.....find out the answers to some of those questions and you'll know which one you have to pick.
 
S

Skye

New member
I would call the plan administrator and find out some of the answers to your questions. We have a PPO and I much prefer that. No pre-authorizations and no small network. There is no lifetime max on my PPO. A small co-pay to pay for doctor's visits, copays with meds that are affordable (not 80/20), and I have the option of going out of network if I ever need to and paying that 80/20 for the visit. I had an HMO in FL and found it very constraining. That was about 10 years ago though and maybe things have changed. I say write down some questions and make some calls: what is the lifetime max on both plans, what are the co-pays for meds.....find out the answers to some of those questions and you'll know which one you have to pick.
 
S

Skye

New member
I would call the plan administrator and find out some of the answers to your questions. We have a PPO and I much prefer that. No pre-authorizations and no small network. There is no lifetime max on my PPO. A small co-pay to pay for doctor's visits, copays with meds that are affordable (not 80/20), and I have the option of going out of network if I ever need to and paying that 80/20 for the visit. I had an HMO in FL and found it very constraining. That was about 10 years ago though and maybe things have changed. I say write down some questions and make some calls: what is the lifetime max on both plans, what are the co-pays for meds.....find out the answers to some of those questions and you'll know which one you have to pick.
 
S

Skye

New member
I would call the plan administrator and find out some of the answers to your questions. We have a PPO and I much prefer that. No pre-authorizations and no small network. There is no lifetime max on my PPO. A small co-pay to pay for doctor's visits, copays with meds that are affordable (not 80/20), and I have the option of going out of network if I ever need to and paying that 80/20 for the visit. I had an HMO in FL and found it very constraining. That was about 10 years ago though and maybe things have changed. I say write down some questions and make some calls: what is the lifetime max on both plans, what are the co-pays for meds.....find out the answers to some of those questions and you'll know which one you have to pick.
 
S

Skye

New member
I would call the plan administrator and find out some of the answers to your questions. We have a PPO and I much prefer that. No pre-authorizations and no small network. There is no lifetime max on my PPO. A small co-pay to pay for doctor's visits, copays with meds that are affordable (not 80/20), and I have the option of going out of network if I ever need to and paying that 80/20 for the visit. I had an HMO in FL and found it very constraining. That was about 10 years ago though and maybe things have changed. I say write down some questions and make some calls: what is the lifetime max on both plans, what are the co-pays for meds.....find out the answers to some of those questions and you'll know which one you have to pick.
 
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