We are planning on starting a family next year, Inshallah. It’s an open enrollment period at my work and I can’t seem to decide which insurance option is best for me. My husband is also covered under my insurance plan as his company plan is pretty expensive. My company offers Aetna HMO and Blue Shield Blue Cross PPO. HMO and PPO both would cover 80% of maternity inpatient expenses and I will have to pay 20% out of pockets. Any thoughts, which plan would offer most coverage.
In general, PPO's are better b/c you don't need a primary's care physician's recommendation to see a specialist if that need ever arises.
Assuming coverage and cost of both plans are identical, PPO would be better. And if you're planning on getting pregnant anytime soon (within a year or 2) then I would also strongly recommend you call your local hospitals to find out general labor&delivery cost under each insurance. Basically call and ask the billing department which insurance would make your co-pay lower.
Most physicians also prefer PPO's so if there is a specific M.D. you ever want to choose, you chances of getting in are higher with a PPO (example: Let's say there is a specific OB you want who's in high demand).
P.S. I don't know much about insurance. Hubby usually takes care of all that for us so I actually showed him your post. The above are his words (he's also a M.D.).
my sincere recommendation is to talk to people who have the plans you are considering. in paper, PPOs are better for those with specific conditions. i shifted from an HMO to a PPO plan from the same company (Anthem blue cross) earlier this year. the PPO looked wonderful as far as the brochures and everything the agent said went. but they now bill me for things i have never ever been billed for before. a normal visit for a long cold is billed as out-patient visit. its a mess. talk to people with the exact plans you are considering. there is very little visibility into billing practices and negotiated rates and coverages as an outsider.
talk to the companies and ask them about the maternity expense, heck even check about coverage for circumcision- in case you have a boy!
We have HMO (Harvard Pilgrim) and I didnt have to pay a penny for my pregnancy/child birth/circumcision and let me tell you mine was one complicated one with visits to the L&D so very often, I used to get the invoices and they charged like thousands of dollars for overnight stay in the ER or L&D but Alhamdulillah I didnt pay anything out of pocket, and even the first year of child's visit to the docs dont have a co payment! so for us HMO has been the best!
I also agree with paheli. I've had both hmo and ppo. Ppo gives you more flexibility and benefits. With hmo you will need referrals and have to stay in network for the most part.
I also had a risky prgnancy and was required a mri on a short notice. My son stayed in NICU for few days and I had an ultrsound every week. I also had to visit surgeons. I didn't pay a single penny I under ppo. My insurance even provided breast pump for free. Look into all of these benefits.
HMO is cheaper and PPO you may have to pay more in general. With an HMO, if you need to see any other doctor than your primary care one, you would need a refferal from the primary care doctor but with PPO you can go to anyone who accepts your insurance, hence the higher costs. If you don't have recurring medical needs and want to save HMO is good.
PPO looks good on paper but they have so many loopholes. You'll get bills from all aspects. If you are expecting a BIG medical expense year I'd choose the HMO option
I understand about the HMO and requiring referrel but honestly I never had an issue with that.. like I said, with my pregnancy I had to see several specialists before and after my pregnancy and referel was all taken care of at the docs office!I never had to wait for anything to come through before I was seen! so yep it wasnt as bad as it seems on paper!