| Posted By |
Message |
|
|
Can anyone help re: HMO vs. POS?
I need help!
My insurance is completely paid for by my employer (I do not have to contribute at all). Taking this into consideration, should I choose an HMO plan or POS plan?
Can someone explain the basic differences to me? I'm looking it up online, but I keep finding HMO vs. PPO and PPO is not an option for my insurance.
TIA!
|
Posted 11/19/07 12:53 PM  |
| |
|
Long Island Weddings
Long Island's Largest Bridal Resource |
Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
|
Re: Can anyone help re: HMO vs. POS?
I would opt for a POS because you have the ability to go out of your network for doctors. This way, if you like a doctor that's not in your network you can go and it won't be an out of pocket expense. Same thing with hospitals.
HMO is too confining if I had a choice.
|
| Posted 11/19/07 12:59 PM |
| |
|
Kara
Now Zagat Rated!
Member since 3/07 13217 total posts
Name:
They call me "Tater Salad"
|
Re: Can anyone help re: HMO vs. POS?
Article comparing HMO, PPO, and POS Health Coverage
|
| Posted 11/19/07 1:08 PM |
| |
|
CunningOne
***
Member since 5/05 26975 total posts
Name:
|
Re: Can anyone help re: HMO vs. POS?
I'm not a fanof HMO;s, especially when you just want to go see a specialist, like a dermatologist. I would chose something like a PPO. NOt sure about POS. I have a Direct HMO and I do not need referrals to see specialists, which I like.
|
| Posted 11/19/07 1:14 PM |
| |
|
DaniJude
You're My Home <3
Member since 11/06 14815 total posts
Name:
Danielle
|
Re: Can anyone help re: HMO vs. POS?
Posted by Blu-ize
I would opt for a POS because you have the ability to go out of your network for doctors. This way, if you like a doctor that's not in your network you can go and it won't be an out of pocket expense. Same thing with hospitals.
HMO is too confining if I had a choice.
I agree w/ this.
|
| Posted 11/19/07 1:15 PM |
| |
|
GoldenRod
10 years on LIF!
Member since 11/06 26792 total posts
Name:
Shawn
|
Re: Can anyone help re: HMO vs. POS?
Your employer is paying for your coverage, but you'll probably have to pay the difference for an out-of-network provider. For some of our plans, the insurance lets you go out-of-network, but they only cover 80%. That means if you have a complicated pregnancy, or emergency surgery (both of which we had last year), it could cost $20k out of our pocket. 
It's nice having the flexibility to go to any doctor you want, but for me it was better having 100% of the bills paid.
|
| Posted 11/19/07 1:17 PM |
| |
|
|
|
Re: Can anyone help re: HMO vs. POS?
Thanks everyone! I really appreciate your help
|
| Posted 11/19/07 1:32 PM |
| |
|
Kara
Now Zagat Rated!
Member since 3/07 13217 total posts
Name:
They call me "Tater Salad"
|
Re: Can anyone help re: HMO vs. POS?
Posted by GoldenRod
Your employer is paying for your coverage, but you'll probably have to pay the difference for an out-of-network provider. For some of our plans, the insurance lets you go out-of-network, but they only cover 80%. That means if you have a complicated pregnancy, or emergency surgery (both of which we had last year), it could cost $20k out of our pocket.
It's nice having the flexibility to go to any doctor you want, but for me it was better having 100% of the bills paid.
On the flip side (just sharing another opinion), I have a PPO and greatly prefer it. I have a small copay for in-network docs and that's it. The 80% only kicks in if I go to someone out of network. I don't pay for 20% of all my medical bills -- only if I go to someone out of network. To me, after watching my mom, aunt, and uncle battle cancer and my father have open heart surgery, being able to choose my own doc or specialist is HUGE. I want the flexibility to choose whoever I want if something awful happened.
|
| Posted 11/19/07 1:44 PM |
| |
|
Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
|
Re: Can anyone help re: HMO vs. POS?
Posted by GoldenRod
Your employer is paying for your coverage, but you'll probably have to pay the difference for an out-of-network provider. For some of our plans, the insurance lets you go out-of-network, but they only cover 80%. That means if you have a complicated pregnancy, or emergency surgery (both of which we had last year), it could cost $20k out of our pocket.
It's nice having the flexibility to go to any doctor you want, but for me it was better having 100% of the bills paid.
There are deductibles and co-insurance out of network but there are also breakpoints where you don't pay the out of network charges anymore. It would never cost you 20K under most plans.
My out of network out of pocket max is $4K. After that, the plan pays 100% no matter who I go to. This was literally a life saver this year when I went to a surgeon at Mt. Sinai who was out of network. I still haven't reached the $4K for the year. In addition, I have a medical savings account which lets me pay for these out of network charges on a pre-tax basis.
Probably more than you wanted to know, but don't let the out of network charges scare you. The peace of mind to go to any doctor you want is enough for me.
|
| Posted 11/19/07 1:44 PM |
| |
|
Kara
Now Zagat Rated!
Member since 3/07 13217 total posts
Name:
They call me "Tater Salad"
|
Re: Can anyone help re: HMO vs. POS?
Posted by Blu-ize
Posted by GoldenRod
Your employer is paying for your coverage, but you'll probably have to pay the difference for an out-of-network provider. For some of our plans, the insurance lets you go out-of-network, but they only cover 80%. That means if you have a complicated pregnancy, or emergency surgery (both of which we had last year), it could cost $20k out of our pocket.
It's nice having the flexibility to go to any doctor you want, but for me it was better having 100% of the bills paid.
There are deductibles and co-insurance out of network but there are also breakpoints where you don't pay the out of network charges anymore. It would never cost you 20K under most plans.
My out of network out of pocket max is $4K. After that, the plan pays 100% no matter who I go to. This was literally a life saver this year when I went to a surgeon at Mt. Sinai who was out of network. I still haven't reached the $4K for the year. In addition, I have a medical savings account which lets me pay for these out of network charges on a pre-tax basis.
Probably more than you wanted to know, but don't let the out of network charges scare you. The peace of mind to go to any doctor you want is enough for me.
Excellent points.
And this is also all assuming you go out of network for these things. I don't pay extra for the docs in my network -- and there are sooooo many in my plan.
Message edited 11/19/2007 1:46:02 PM.
|
| Posted 11/19/07 1:45 PM |
| |
|
Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
|
Re: Can anyone help re: HMO vs. POS?
Posted by Kara
Posted by Blu-ize
Posted by GoldenRod
Your employer is paying for your coverage, but you'll probably have to pay the difference for an out-of-network provider. For some of our plans, the insurance lets you go out-of-network, but they only cover 80%. That means if you have a complicated pregnancy, or emergency surgery (both of which we had last year), it could cost $20k out of our pocket.
It's nice having the flexibility to go to any doctor you want, but for me it was better having 100% of the bills paid.
There are deductibles and co-insurance out of network but there are also breakpoints where you don't pay the out of network charges anymore. It would never cost you 20K under most plans.
My out of network out of pocket max is $4K. After that, the plan pays 100% no matter who I go to. This was literally a life saver this year when I went to a surgeon at Mt. Sinai who was out of network. I still haven't reached the $4K for the year. In addition, I have a medical savings account which lets me pay for these out of network charges on a pre-tax basis.
Probably more than you wanted to know, but don't let the out of network charges scare you. The peace of mind to go to any doctor you want is enough for me.
Excellent points.
And this is also all assuming you go out of network for these things. I don't pay extra for the docs in my network -- and there are sooooo many in my plan.
True..I have many as well. My hospital was in network and so was the anthesiologist, but not the surgeon. My out of pocket for the whole thing was $800, but I loved my surgeon.
One more thing, out of network doctors negotiate with your insurance company through multi-plan which saves you money.
|
| Posted 11/19/07 1:49 PM |
| |
|
JenniferEver
The Disney Lady
Member since 5/05 18163 total posts
Name:
Jennifer
|
Re: Can anyone help re: HMO vs. POS?
You have to see if your current docs are in -network, and then check even more carefully because for exampole my doc is in network for most plans, but NOT for the HMO version of the plans.
I would always opt for the POS. It's better to pay co-pays than to be slapped with a huge bill if you need to go out of network. In addition HMOs pay very little to docs (which is why my doc won't take them) and I found when I had one I'd be rushed in an out of the office and the doctors were just not the same. I had shingles when I was younger and had an HMO and I saw the doctor for literally 5 minutes and he told me to "wash my hands" (which has nothing to do with how one gets shingles!!!) and I had to argue for a referral for a specialist. I hate dealing with referrals. I will personally NEVER have an HMO, even if it costs me more to have a POS or PPO
|
| Posted 11/20/07 11:44 AM |
| |
|
