Is Your Insurance HMO or PPO?

I had the worst experience with an HMO...I always chose one becasue it was cheaper...and I learned my lesson the hard way.

We have PPO and I would never go back if I had a choice about it. You never need a referral...

I would go PPO if the cost allowed...I HATE HMOs...(Did you know it is against the law, at least here in Texas, if you are in an HMO for an non-HMO doctor to even treat you...even if you are willing to pay them out of pocket in cash...it is against the law...that floored me and left me without a pediatrician for my two day old infant.)

Sorry HMOs really boil my blood!!

I would never, willingly, have an HMO.

My bias, in part, stems from growing up around doctors (familily and their friends) who universally HATED the HMO system. Hundreds, if not thousands of time, I had to listen to them be FURIOUS about patients who were recieving substandard care FROM THEM, because they were HMO'd and the insurance company wouldn't allow them to treat their patients as they needed to be.

My bias, in part, also stems from working in healthcare... and seeing the exact same things.

My bias, in part, also stems from there being 2 HMO choices in our area. GroupDeath & Po'People'sPlan (state insurance option which only covers bottom of the barrel minute clinics). GroupDeath I won't even go into (shudder) but I find it soap box worthy INFURIATING that about half of our poor are given this AWFUL HMO insurance plan where their kids' eyes are being glued shut, medications mismanaged, simple illnesses allowed to progress onto lifethreatening conditions... becuase the only providers covered are these fly-by-night med-school-dropout sanctioned-and-can't-even-get-a-job-at-group-death "doctors" (most aren't doctors... there's rarely even one real doctor per clinic, I'm not joking that most are staffed by med school dropouts). When GroupDeath is the BETTER option, the world is on it's head.

Aetna PPO is the only way I would go.

With Kaiser, you need to make an appointment to die...if you can get through on the phone.

PPO. The slight increase in monthly premiums is completely worth the peace of mind I have.

We had an HMO for one year and I hated it. While under our PPO, my son had ear tubes put in and was seeing an ENT for regular check-ups. He was due for a check-up during the HMO year and I asked for the referral from our pediatrician, thinking it was a no-brainer & of course they'd give it to me. They said no. I asked again a few months later & again they said no. Finally, at the end of our HMO year, when I asked the third time, they reluctantly agreed. I was outraged and hated that feeling like I didn't have control of our healthcare choices. The referral process was a giant pain. We went running back to the PPO at the next open-enrollment period. This year, however, the cost of the PPO went way up, so we opted for an HSA plan. Still have access to the PPO network of doctors, no referrals needed, and basically pay for healthcare via a "debit" card set up with the bank that administers the HSA. My husband is a certified math geek (!) and this was actually the cheapest option for us, even when all of the out-of-pocket costs are factored in. We've had two ER trips, several specialist visits (my son broke his arm) and a few doctor's office visits and have had no problem paying for our portion. I know you didn't ask about HSA plans, but just throwing my 2 cents out there on those. :) To answer your question, though, I MUCH preferred the PPO and felt it was worth the extra cost (before HSA became an option for us).

Through my job, the HMO option is more expensive than the PPO options. Significantly more expensive if you choose the high deductible (5000 family) option that I have. For us, we have well child visits covered, plus my employer puts 2000 each year into an HRA (health reimbursement account), so going PPO is a no brainer. If we didn't have the HRA, it would still be cheaper, even with my son's 1000 cardiologist visit every year. We don't get sick that often and don't have any recurring prescriptions.

Check your options with different deductible choices and you may be surprised how close the costs are. You can always start an HSA to save the higher deductible in case something catastrophic occurs.

We have Aetna and prefer their PPO program. It comes with a lower deductable and a higher dental limit (I have lots of weak teeth!) and it covers more of our dental than the HMO. We've also seen that a lot of places don't accept Aetna's HMO for some reason. Good thing, since my PT office that I start at on Monday only accepts the PPO.

I hate my current HMO which is blue cross/blue shield. I liked Kaise when it was my HMO in the past.
If I had a choice I'd go PPO, but they are much more expensive.

I have Aetna HMO for the last 6 years and it hasn't been a problem. Referrals are all electronic and my doctors office and pediatric office have never given me a problem about seeing a specialist. Over the years my copay to see a specialist has gone up to $50 which I think is a lot and I was in physical therapy for my knee and that was $40 a visit. My primary physician copay is $20.
My husband is self employed so it was MUCH cheaper for us to get an HMO. I was really reluctant to but I now would defineately recommend an HMO. (FYI... My insurance has always covered which ever specialist I wanted to see).

I have an HMO plan through Kaiser Permanente and have never had problems with referrals. They have their own network of doctors so they allow self referrals for most things like the allergist, OB/GYN, eye doctor, mental health services, vision services, etc. When I had an HMO plan through Sutter Health they would always make me go to my primary doctor for referrals to everything including the allergist & OB/GYN!

we have an open access HMO. That means, we can still choose our own dr's. We can go anywhere that will take our insurance. If it's out of network, then we have like an extra $10 co pay. Not a big deal to pay a little more for a good dr

We have had so many different types of health insurance over the years. So much depends on what you need it for, does anyone in your family have heath conditions that require you to go to the doctor a lot or to specialists?
One of the most expensive options we ever had was one of those savings account things. I can't remember if it was the HRA or HSA. That was the year I was pregnant and delivered my third child. She is our ~$3000 baby of out of pocket, not to mention what we paid out of every pay check for the premium, and that was just care and delivery, it got worse for all of her "well baby" checkups or an other medical for anyone else in the house. That was the worst we ever had!
PPOs have been hit or miss. They've been costly.
Right now we do actually have an HMO, the first time in a long time that we do. The pediatrician we've been seeing since my first child was born is covered as is my son's eye doctor for his glasses. None of us have any health issues that a regular doctor can't take care of so we don't need specialists.
So much of the plan depends on what the employer is willing to offer.
When picking we go through and see where our doctors are covered first. We are loyal to some of our doctors and in the past it has been worth whatever extra we've had to pay to go to those doctors.

I have a really good HMO right now. My DH works for the State so the insurance is really good. I don't have to get a referral for specialists at all. My pediatrician just gives me the contact information for one and tells me to set up an appointment. My daughter had outpaitient surgery last month. Pre-approval was needed, but that was handled in the background by the urologist's office and my insurance. I paid exactly NOTHING out of pocket for this surgery. The bill was about 20K. My DH had a ER visit and hospital stay last year and the only thing we paid was the $250 copay for the hospital admission.

I realize that my HMO may not be typical, but it has really been better for our family.

I've worked with health insurance. (Medical billing for a dr.) I woud never ever have an HMO. They are expensive, limiting, and a freaking pain. Out of pocket expenses vary so much. There are thousands of plans and options. Your out of pocket wold depend entirely on the plan you select.

I thought I'd add that many doctors are moving away from HMOs. So many don't even accept them now. Just something to keep in mind.