Originally Posted by
TangMan99
http:///forum/post/3239377
I work in Health Care be it I.T., but I know the business very well. Each state can be different and we have not had HMOs for many years so thing may have changed from how they worked when had them.
You have to look at each separate and then what it would cost for each of you to be on one plan. The PPO is 1000x times better as they have a better network and you have a lot of freedom with your health care. HMOs are a pain in that you have to get referrals for almost everything that your primary care physician can't handle. You better have a physician you trust also because they get penalized if they do too many referals so some are hesitant. It can also be hard to get an appointment with an HMO as physicians were paid what was known as PMPM (Per Member Per Month) meaning that they were paid by member count and not treatment. If a physician participates in multiple networks, they don't make more to see you in their office. Does anyone remember back in the 90s when HMOs were most common and you would call your doctor with a bad cold? Remember them asking you questions over the phone and calling in a perscription for you? You thought they were saving you a trip and doing you a favor. Not at all. They didn't get paid to see you so they saved their appointments for the patients they could bill and file a claim.
If you have a PPO, you have the best policy and that is why it cost more. If you are both healthy and seldom visit the doctor, it probably doesn't matter what you do. Also compare your out of pocket deductibles to see what you each have to pay vs what you would pay on a single policy. That's probably a wash right now but won't be when you have a family as right now you each have employee only. When you have a family you would either have a single Employee + Family plan or two separate policies being an Employee Plan and an Employee + Child plan. That is where your deductibles will be much more.
If you are planning on having a baby, look carefully at what each plan covers as far as out of pocket maximums, what is covered and at what percentages. God forbid anything happen but if there are complications, you want the best insurance available.
Again, keep in mind that this may have changed and I'm giving you information from a while back on HMOs. Please do your due dillegence.
And yes, HSA are the way the industry is going. If you don't have one now, you will in the next few years.
That is my understanding of it as well. The highlights being on an HMO that they're paid on an enrollment basis not a per visit basis. You need referals for everything not covered by your primary care physician. And finding a doctor can be difficult, since they're not profitable.
