HMO vs Preferred Provider Plans

[itsmyparty]

Just received my open enrollment forms for next year's coverage under the retiree plan...and saw they have doubled the monthly premium for the ppo plan I've always been on. (new rate about $3900 yr for 2 of us) I'm sure to try to convince us to switch to an HMO. If we choose the HMO there would be no monthly premium. I'm tempted...and would like to hear from anyone who has used HMO's and what your thoughts are. Luckily no major problems for my DH or myself at this time...so we don't go to dr. alot..but of course one never knows! Co-pays and prescription costs same on both plans...and I've noticed that even though some costs on HMO are covered at 100%..there are restrictions - ie skilled nursing limited to 30 days per year vs PPO of 80% of unlimited. After next year I'll be on medicare, but my DH will have another 2 yrs until he is (he's retiring end of this year...but no health care coverage so lucky we have mine). Neither of us like the idea of having to go to one doctor first just to ask him/her to refer us to another .. but wondered perhaps its not as bad as we think. Also we need to check to see if our doctors on covered under this plan. Would really appreciate any info/advice/experiences you have!! Thanks all!

 

[CoolChange]

I do not have much to offer other than my own personal anecdotal experience: Without major health issues (assuming/hoping that will continue for a while), I doubt if you will notice much difference between the two. I have bounced between HMO's and PPO's for years and never really noticed much difference.

If I were in your shoes (so close to Medicare, healthy, etc.) I'd probably choose the HMO based on my past experience. However, the PPO does offer the peace of mind from more [possibly just perceived] flexibility if something should go wrong.

Make sure any doctors, facilities, any expensive medicines, etc. that you use (if any) are covered/preferred on whichever plan you choose.

My current company started offering a high deductible/HSA-eligible plan a few years ago; this is what I am covered by now. (Unfortunately, this seems to have incented me to not see a doctor a couple of times when I probably should have.)

Good luck.

 

[itsmyparty]

Thanks so much for sharing your experience .... and good advice about checking coverage. Unfortunately both the ppo and hmo are through Aetna...and they are not good to deal with if any procedure, etc. outside of 'generic' is required. Like you, luckily, we don't need much at this time but as a 'for instance'.....I have a knee that is giving me problems, but through exercise I've managed to improve it and live pretty normal life. However, the idea that one day I may need replacement surgery exists. Interestingly, last year, the ceo of Aetna was interviewed and said they are thinking of sending people covered by them to Asia for hip and knee surgeries as they cost much less there. What a guy! Thanks again!