XP: HMO vs. PPO??

Jem04

I currently have an HMO (Blue Cross Blue Shield), but now I need to sign up for 2009 benefits.

Any good/bad thoughts on HMO vs. PPO?  I am pg with twins due in May so I am concerned that I might have more complications/bedrest/NICU.

I also need to decide how much to put aside in the flex spending acct for medical expenses... oh, fun.

Thanks in advance!

LilSurferGirl

We have a PPO and I looked at switching to the HMO before my boys were born, but decided to stay with the PPO because:

• I could stay with my current OB and not have to switch mid-pregnancy to an in-network provider.
• I could get any testing, u/s, see the peri in addition to my OB, etc. without needing permission or a referral.
• Did not want to fight with HMO if the boys had needed any NICU time or special care after birth.

The downside is that we did spend more out of pocket, but I put the maximum into our Flexible Spending account and anything over a certain amount was covered 100%, so we knew we'd have a set OOP expense that we planned for.  My boys ended up not needing NICU time, but I had complications that made me glad I had the Dr.'s I chose - not chosen for me by an HMO. 

pea-kay

be sure to compare not only premiums, but also copays and max out of pockets for hospitalization. we put the boys on DH's insurance because the premiums were much lower, but it was stupid, because we now owe $2700 more in copays than we would have if we'd put them on mine. ugh.

lajolla09.30.06

We went with an HMO because that way you never have any "surprise" expenses.  With the PPO option we had your doctor can refer you to have lab testing or other services etc and they can be out of network without you knowing, which means you're stuck paying a lot.  With our HMO if the doctor sends us somewhere we know it's covered no questions asked (the upside of managed care).  We have been really happy with how our coverage worked out... and we had 2 weeks worth of NICU time, no problem with payment.

hopewill

i have blue cross blue shield as well...did they tell you about their healthy expectations program?  when i was looking for a dr. they told me and our deductible will be waived just for signing up...

Jem04

Thanks!  I'm going to call BCBS and get some answers to my questions.  On the surface, it seems like the HMO will be a lot cheaper, but I want to make sure!