All right, I’ve finished my probation period at work and now it’s time to sign up for a health plan. I have two choices, Blue Cross HMO or PPO (at my previous employer, I had a third option - HMO Private Practice which is what I used there). So far, the main advantage that I see to having a PPO is this: I don’t have to go through the Primary Care Physician to get a referral to a specialist (I am quite aware that the approval process for a specialist can be a major pain-in-the-ass, to put it mildly). The disadvantage is that it’s more expensive - about $2.50 more per week + $5 more co-pay. OK, so that isn’t anything that’s going to break me but I do question whether the extra expense is worth it. Other than that, they seem pretty much the same (same things covered, many doctors’ names appear in both directories, etc.) Any feedback here regarding HMOs vs PPOs is welcome. In case it matters, I’m 30ish and in good health. I do participate in potentially dangerous activites (hiking, backpacking, mountain biking), but nothing extreme.
If you’re single, don’t have any health conditions, and don’t mind which doctor you go to the HMO is probably fine. I have a PPO, but my husband and children are also on it and we go to lots of different doctors (GP, OB, pediatrician, dermatologist, etc.) I found the PPO invaluable when I was pregnant, because my doctor could order any tests she wanted without my having to worry about arguments from the insurance company. That’s the main headache with a PPO–your doctor is limited on what treatments he/she can give in certain cases. (Unless you pay for them out of your own pocket.)
This is really more an opinion call rather than anything I can base in fact but personally, I’d go HMO. Despite all the bad press you hear, I’ve had Kaiser Permanente for years and never had a problem with the system. In fact, they were better than the PPO I had at my former job. I can’t speak to how good/ bad Blue Cross it though. My thinking was this:
- 99.9% of the time I’m healthy, so why pay more?
- If I feel something coming on, and I suspect the HMO will jerk me around, I’ll go before it comes serious
- If it’s a sudden illness or injury, I’ll deal with it when it happens since I’m likely to have problems with either system not wanting to see me ‘right away’.
I suppose I’ll probably be eating my words one day when I get cancer and die in a waiting room somewhere because you can’t get seen by anyone in a timely manner with an HMO, but at the moment, I’m happy with my choice.
That’s pretty much it in terms of differences. If you ever get really sick, the PPO is better. Another option that you did not mention is a POS. That’s a Point of Service contract, which offers an HMP or PPO plan with the option of the traditional 80% 20% plan if you go out of network. POS offers the best choices. It also costs the most.
Keep in mind that no-one plans to be sick. Choose the best of what you are able to afford.