So I have to choose between HMO (St. Mary's) and PPO (Blue Cross/Blue Shield).

HMO costs me $75/month out of pocket. What do you guys recommend? I have a little info right now on the HMO (copays are reasonable, yearly max O.O.P. is $4500) but I won't have details on the PPO until next week.

 

Tough to make a decision without details on the PPO

 

Yeah I know. I'm just looking for general views on PPO vs. HMO. I know the rules can be very different.

 

I've had PPO through Blue Cross/Blue Shield for a long time. No problems. I like it because I am broken and can go see who I want without checking with my primary doctor first to see if it's "okay".

I have a family, though, so that factors into my decision as well.

I've never had an HMO before, though. From what I've heard, some people like it because it's kind of like a one stop shop kinda deal.

 

yeah, i think it's about who is in the network or something right, i just started doing my own insurance this past year...so I'm not too saavy on it, but one you need to see someone within the network, other you can see whoever you want right?

 

Yeah, a major factor in my decision is the fact that I am a young, healthy and single male. My monthly premium for the HMO is $136 a month... pennies. I haven't had insurance for a few eyars so I plan on taking a physical and making a few visits int eh next 6 months, but I don't anticipate anything coming from that. So I'm more concerned about peak out-of-pocket expenses and convenience down teh line for routine stuff than I am about individual visit costs.

 

wait, just called my mom, she does insurance for a doctor's office, HMO is you go only where your doctor tells you where you can go, cheaper per month, but don't cover some of the specialized stuff, PPO is more, but you get flexibility as to who you can see and what they will and won't cover

Also, HMO you can't sue your insurance company for not covering something...they make you sign something saying you can't

also, not too many doctors now a days accept them

 

the PPO will probably have a higher monthly cost and a higher OOP cost, but you get a lot more freedom with a PPO.

there's a plan that's been popping up lately called an EPO which is kind of a cross between an HMO and PPO. you can see specialists without referrals, but only as long as they are contracted with the insurance company (in network). a PPO lets you see specialists that aren't contracted (out of network) but it costs a bit more.

are you sure that $4500 if for you alone? most insurances are $1500 for a single person, $3000 for a couple, $4500 for a family.

 

St. Mary's has huge infrastructure here. True I wouldn't get much choice, but any specialist I might need to see would be available to me locally. I would have no real basis for choosing one over another anyway, at least the first time I went in to see someone.

I expect my office visits to be infrequent, so seeing a PCP would be nice to be able to switch as I felt like doing.

The $4500 was the only number I saw under yearly limits.

 

dont ever split a thread while I am replying to it

I was saying

I enjoy my HMO very much.

 

Type faster.

 

:rotfl: I was like dood, I was typing all these replies, and now he makes another thread, i gotta copy and paste all my ****en posts over to this thread no..........oh wait a sec...

 

oh dude.. mavis says I type pretty damn fast as it is

 

Well, if it's not your typing speed, must be your thinking speed.

 

In general I prefer PPO to HMO, but the specifics of each deal could make me flip flop. Where I am working, the cost is relatively the same which makes it all the easier for me to pick PPO. Growing up, I was covered by an HMO, and I was happy using them too. It really comes down to the specifics, and how often you think you'll be going to the doctor.