HMO vs PPO — The Bump
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HMO vs PPO

To go along with all of the open enrollment questions being posted lately, I was wondering how many of you have an HMO versus a PPO.  My husband demands every year that we stay in his PPO plan while I always try to sway him to the HMO side.  It is a savings of $2,500 a year in premiums if we went with his HMO.  He is so afraid that we won't be able to get to the doctor that we need to get to in case of a serious illness or injury if we switched to an HMO.  I keep reminding him we can get to that doctor after we go through the referral process, but he doesn't like that idea.  I would love to actually join his high deductible PPO plan in 2015.  We are hoping to have a baby in 2014 so that plan doesn't make sense for us next year, but with all of us being healthy, I think we could actually make out really well with a HDHP and HSA account (His employer would fund over 80% of the deductible through an HSA account). 

Just curious what everyone's thought process is when choosing HMO v PPO.

Thanks.

Re: HMO vs PPO

  • I have a PPO.  It's a personal preference to be able to choose my doctors, choose when I see a specialist, and a desire to keep the specialists I had when I graduated.  I have always had a PPO (even when on my parent's insurance) so it's what I'm used to and what I'm comfortable with.
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  • PPO- I like not having to worry about getting referrals if I need to see a specialist.
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  • I've been on all types of plans and it just depends; some HMOs are difficult to deal with and some are not.  I am on an HMO right now and it is great.  There is a 24/7 urgent care right down the road, I never have trouble getting in to see my primary care doc or a specialist if needed, and everything has gone very smoothly.  I was on an HMO way back when I first got out of college and that company was a much bigger hassle.
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  • You should check to see if your HMO is an Open Access plan. That would mean you don't have to have your care coordinated by your PCP and you can make an appointment with any doctor in the network. If it's a traditional HMO that you need to get an actual referral from your PCP, it can be a real PITA.
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  • I'm glad I asked the question - I didn't realize how much of a pain getting a referral can be.  The cancer example is enough to make us stay with a PPO.  Thanks.
  • Nechie122Nechie122
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    edited November 2013
    My DH is a doctor and he always says insurance is for the worst case scenario. Sure, we're healthy now, but we pay more for a PPO because if something happens, we want to be protected. One bad car accident where you're taken to an out-of-network hospital could wipe out the entire amount you would have saved on premiums. And then some.

    Besides, it's pre-tax dollars so that mitigates the cost a bit.
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  • Pips09 said:
    You should check to see if your HMO is an Open Access plan. That would mean you don't have to have your care coordinated by your PCP and you can make an appointment with any doctor in the network. If it's a traditional HMO that you need to get an actual referral from your PCP, it can be a real PITA.
    We have an open access HMO and have had no issues seeing whoever we like.  I haven't seen or talked to my primary care doctor in a couple of years.
    BFP #1 9/2010 (lost our baby at 21 weeks) BFP #2 8/2011 (ectopic pregnancy) BFP #3 10/2011 (chemical pregnancy) BFP #4 12/2011 (Abigail born 8/15/12) BFP #5 5/2013 (Griffin born 1/23/14 with heart defects, now repaired!)

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  • I think it also depends on your provider - I have the Kaiser HMO and I couldn't be happier. EVERYTHING is covered, there's no questions on billing, and if I need to do lab work or anything of the like, it's literally just a walk down the hallway. Kaiser is a well oiled system, and I've never had any problems with it. I can't say the same for Aetna or BCBS though.

    That being said, I also have never had any particular loyalty to one doctor, and in my world, they're all pretty interchangeable to me. I also have the option to switch if I were to decide I didn't like my PCP or DD's pedi. 

    DH has PPO through his employer (He would LOVE to be on Kaiser, but the cost to add him to my plan is prohibitive) and can't stand it. His billing is a mess, there's no central place to determine where he should go, etc. 
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  • I've always been on HMO. DH was on PPO prior to us getting married but he switched to HMO. Fortunately, we don't have many medical needs. Everything was covered with LO's birth. She had some complications in the first 2 months but referrals were no issue. We always got in to see specialists within a day or two.

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  • I have a PPO. I have always had one due to a pre existing condition. I prefer to have the same doctor who knows my health history and for meds it's a little bit cheaper.
  • I've done both (for financial reasons) and I do prefer PPO to HMO.  Mainly having to take time off of work to see the GP before being referred to a specialist was REALLY annoying, and burns through PTO like nobody's business. I understand a savings of $2,500 per year, so that's a tough one, if we were tight financially we would absolutely go HMO for a year (if everyone was healthy).
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  • L12541 said:
    Pips09 said:
    You should check to see if your HMO is an Open Access plan. That would mean you don't have to have your care coordinated by your PCP and you can make an appointment with any doctor in the network. If it's a traditional HMO that you need to get an actual referral from your PCP, it can be a real PITA.
    We have an open access HMO and have had no issues seeing whoever we like.  I haven't seen or talked to my primary care doctor in a couple of years.
    This is me too. Actually, my plan is an open access EPO, but I was told that's the same as HMO. All of the doctors I previously saw (which wasn't many, just my midwife, dematologist and DS's pediatrician - I don't even have a primary care doctor) were part of the network as are all of the hospitals near me. I'd think I'd have to actually try pretty hard to find someone out of network.
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  • Not to come off as a drama queen but I had kaiser and if it was not for my mom fighting for me I probably woud have died before they would have approved a much needed test. Long story short I had undignosed Crohn's which caused me to not be able to eat, major stomach pains and weight loss I was down to 86 pounds 120 is my normal weight. Kaiser doc refused to approve the colonoscopy the GI doc recommended saying I was just a lying teenager who was aniroxic and needed to see their specialist on eating disorders. I finally got the test and it was Crohn's You could not pay me to have an HMO ever again. I hear kaiser has gotten better but I only ever hear good things frm from my healthy friends who have not ever needed anything outside the kaiser buildings
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