HMO vs PPO

cloudymeatballs

I am up for our insurance renewal, or whatever it is called.  Right now we have a PPO, not pregnant yet, but maybe next year?  I was wondering, what does everyone have and do you like it?  Why? If no, why?  Thanks girls, just trying to get something that will benefit us better.  Happy Hump day!

LooneyLife

This is really a very complicated subject and generic answers probably won't do you much good.  Just because one person has Aetna doesn't mean they have the same coverage as another person with Aetna.  Plans vary greatly.

There is a lot to consider...procedures/prescriptions the plan covers, copayment, coinsurance, deductible, OOP max, referrals, and on and on.  Since you're TTC, I'd look into maternity care and what you'd have to pay for a pregnancy and delivery.  It also wouldn't hurt to just look and see if any plans available to you provide IF coverage.  Hopefully you'll never need it, but it's good to look into (if only to know what's available to you) during open season.

cloudymeatballs

Thanks @looneylife I have been looking and just so much stuff to look into.  My goodness. Thanks though, I didn't think to look into that stuff!!!

sparklingdiamond

I agree with PP.  Also, if you already have a doctor you like, you may want to see what plans they are listed in.  Like, mine was always in the PPO plans, but not the HMO plans.

LuckyAngel07

We had DH's HMO plan very very briefly (basically just during the months I was unemployed after getting laid off and before getting hired at my new company). I vastly preferred the coverages in the PPO plans to that HMO. But even his company's PPO plan through Blue Cross was different from my previous/current PPOs plans through Blue Cross. A lot depends on what the individual company decides to have in their plan coverage.

I know it's a lot of info, but look in detail at what each plan offers and covers. My PPO plan has zero deductible for all in-network providers. That means I've got no deductible to hit before I get coverage. My copays are also very reasonable, especially for in-network providers. However, there are things my insurance won't cover, IF treatment being one of them. That's thankfully not an issue anymore, but I was something I was starting to give serious consideration to just a month ago as far as putting money aside for treatments I thought I'd have to pay fully OOP. If there's a plan with good pregnancy/postpartum/IF coverage, I'd lean toward choosing that one.

cloudymeatballs

I don't even know how to look.  I get on the websites, trying to search my doctors and these new hmo plans, and I can't even search.  Uggghhh  I wish more things were done with actual people!   

LuckyAngel07

cloudymeatballs said:

I don't even know how to look.  I get on the websites, trying to search my doctors and these new hmo plans, and I can't even search.  Uggghhh  I wish more things were done with actual people!   

Contact your benefits person in HR. They should have plenty of informational material to give you in helping choose during the open enrollment period.

cloudymeatballs

Thanks Luckyangel, you're the best!!