Comments on: Choosing a Health Insurance Plan

By: Ashley Stokes

Ashley Stokes — Tue, 08 Apr 2008 19:00:58 +0000

employee in Kentucky has reached lifetime maximum benefit. What can they do?

By: bill

bill — Fri, 01 Jun 2007 20:39:25 +0000

I have bc/bs and just realized that after my deductible of $2500, I’m only covered at 80% thereafter. Additionally, I found out that it does not cover wellness/preventative treatment. I think it’s time to find better coverage.

By: J

Thu, 30 Nov 2006 23:07:01 +0000

PPO always. We never consider the HMO, we prefer flexibility of seeing the best doctors, instead of just what’s in network. Granted, I have had a lot of strange accidents so I use my medical more than most.

By: gmanbox

gmanbox — Wed, 16 Aug 2006 14:50:42 +0000

I too work for a managed care company.

You didn’t state which BCBS your plans are from (they’re like franchises and differ a bit in overall quality), but overall good company. I’m summarizing a few things you need to check:
-you didn’t mention pharmacy. This is pretty important too. see what the differences are in co-pays, deductibles, etc. and compare against what you used up last year/anticipate this year.
-check your current physicians that you really like to see if covered in either plan.
-Confirm that you need to see a PCP every time if have HMO. Unlike what people think, HMOs have evolved and dont always need a gatekeeper.

Right now from your comments, HMO is the winner. good luck.

By: Cuddy

Cuddy — Wed, 16 Aug 2006 12:54:43 +0000

I had the BC/BS HMO plan for the last 3 years and just this year switched to the PPO. I am much happier with the PPO. Waiting for referrals often led to not even bother with going to the doctor at all. I live in the city (Boston) – and getting in to see my PCP would take days. Now I can just call any doctor and go in for a visit.
Excellent point made by Rob – you want the best doctor for the job (PPO) not who the HMO says you can use.

By: Matt

Matt — Tue, 15 Aug 2006 12:31:37 +0000

Wow. Your post just reminded me of something really important. I need to check the “out of state” coverage on my medical plan. (I’ve got the HMO at work.) If it’s as bad as yours, then I’m going to be in serious trouble when I move to Indiana. Because even though Highland IN is a seperate state from Chicago IL the same way Windsor is a seperate country from Detroit…um…that does mean that, literally speaking, any doctor whose office I can get to from home in a hurry is going to be “out of state”.

By: Rob

Rob — Tue, 15 Aug 2006 11:58:52 +0000

As someone who has dealt with MEDICAL COSTS (my wife was diagnosed with stage 4 cancer at age 22, now 25), this is one area where money should be no object. It is insurance, so risk is a major factor, but this is something you should strech to afford the best you can. CT and MRI scans can easily run you $5-10K, and you always want the best doctors not the one the crappy BS/BC picked because the guy picking was friends with the doctor in elem. school.

By: Medicated Money

Medicated Money — Mon, 14 Aug 2006 23:14:28 +0000

For a family, the HMO plan will always appear to be a better plan. Why; because the insurance companies can make a deal with the physicians in the network to pay a certain amount for service vs those physicians out-of-network.

The problem is your current doctors (OB/GYN, PCP, Ped) may not be covered in the HMO. Remember, many people forget that an OB/GYN physician is a specialist and they are not able to go to that physician during a pregnancy due to out-of-network status.

We currently have PPO’s mostly because we feel the ability to choose is more important than the financial aspect of it; but we are fairly healthy people who do not need to see a doctor often!

However, I would decide based on 2 questions? 1: Are your current physician in-network with the HMO? 2: Is your family overall healthy? If the answers to both are yes, I would go with the HMO.

-Medicated

By: Norm

Norm — Mon, 14 Aug 2006 16:55:02 +0000

I work for a health insurance company and, as such, we get to try some of the newer products a little earlier than some other companies. For the past two years, we’ve had a High Deductible plan and, for us, that has worked out quite well.

Our annual deductible is $6000 (which we never come close to hitting), and our family premium is only $20 a month. Couple that with my employer kicking an extra $1500 a year into our HSA and then my ability to max that out pretax and it really is a nice little plan for a youngish couple in good health.

We had a scare last year with our (then) 1 year old daughter that required an ER trip and some followup EEG’s and EKG’s and I figured out that we still came out ahead with the plan we had.

And, this year, they’ve improved the plan to where it now covers preventive medicine 100% before the deductible.

To answer the question posed, I would go with the HMO our of your options. $600/year is worth sitting in a couple doctor’s offices to me.

By: Rich Slick

Rich Slick — Mon, 14 Aug 2006 14:15:27 +0000

In my experience, HMO’s achilles heal is the requirement for a PCP. You left out one big varible: The amount of time lost waiting to see your PCP so he/she can refer you to the right doctor.

I can’t tell you how many times I’ve had to wait 30+ minutes at a doctor’s office. Imagine having to wait 30+ minutes for your PCP then have to do it all over again once you get the referral you need at another doctor’s office.

Health insurance has gotten so ridiculous. I pay $400/month for PPO coverage with deductables. The REAL cost after factoring deductables and copays is about $600/month!

If you have kids, I can guarantee you will need specialists at some point!