Pamela H in Texas Posted June 27, 2010 Share Posted June 27, 2010 Okay, I start my new job tomorrow. I am staring at this stupid insurance "cheat sheet" and just can't choose one! We used to have really good insurance, a PPO. These seem to be about as good for most things but none are a PPO and the price is actually better, but I don't know how to evaluate them either. Probably necessary information: I have significant health issues and saw several specialists back home. My kids probably have slightly higher than average health needs (my dd sees a couple specialists, my ds has a cpap machieg. Each may need adhd or other meds again, etc). My hubby is a "typical male." Here are the basics of each plan: PLAN ONE: $125/mo HMO with ded of $300/600 20% for most things (ER, labs, Xray, scans, inpatient) $20 office/$40 specialist DME 20% meds $10/30/50 (based on tier) PLAN TWO:$200/mo HMO no ded 10% for most things $15 office/$30 specialist DME 10% meds $10/25/45 (based on tier) PLAN THREE: $220/mo POS no ded 10% most things $15 office /30 specialist DME 10% meds $10/25/45 OPINIONS? I don't really know what POS means. I *think* HMO means we have to always go through a PCP to get to the specialists where when we had the PPO we just did whatever we wanted really. Anyway, I just don't know what to choose. Quote Link to comment Share on other sites More sharing options...
Pegasus Posted June 28, 2010 Share Posted June 28, 2010 Here's an explanation of Point-of-Service (POS): The POS plan is like a combination of the HMO and PPO plans. You are required to designate an in-network physician to be your primary health care provider. You may go out-of-network if you choose, but in doing so, you will have to pay most of the cost yourself, unless a primary care physician refers you to that specific doctor. In that instance, the health plan will pay all or most of your bill. Personally, I like choices so if I could afford it, I'd use a POS before an HMO. I prefer PPO even better. Pegasus Quote Link to comment Share on other sites More sharing options...
Pamela H in Texas Posted June 28, 2010 Author Share Posted June 28, 2010 Oh, the Out of Network does say emergency only for the two HMO ones. It's a $500/1000 ded and 30% coinsurance with the POS. It crossed my mind that out of network may make sense in my case as I would hate to hear "Dr House is the best doctor in this area for people in that situation, but he's not on your plan." BTW, I'm REALLY hoping to find a Dr. House or a set of docs who will work together and figure this stupid illness out. Quote Link to comment Share on other sites More sharing options...
KnitWit Posted June 28, 2010 Share Posted June 28, 2010 Do you have the available cash to choose a plan with a deductible? If you do, I'd choose the deductible Quote Link to comment Share on other sites More sharing options...
Garga Posted June 28, 2010 Share Posted June 28, 2010 Sounds sort of like the 3rd one w/b the best choice. It's an additional $240 a year (compared to the 2nd choice), but then you have more choices of doctors. The first one is too limiting for someone who will be at the drs a lot. I would completely avoid that one if I were you. 20% coinsurance can add up FAST. And the extra $10 here and there for copays for visits and drugs, etc, will also add up FAST. If you didn't need to go to the doctor a lot, it would be good for you. But you're going to go a lot, and so with the kids. If it turns out that you only needed the HMO, then next year you can back down to the 2nd choice and you're only out $240 for the year. Which is a lot of money, but not too much. Quote Link to comment Share on other sites More sharing options...
Scuff Posted June 28, 2010 Share Posted June 28, 2010 Go with the POS. I'd avoid and HMO like the plague. JMO. I grew up with an HMO and never got good specialist care because the DR would leave the insurance and I'd have a new one every other year. They even sent me to a new Children's at 19 because he was the only Ortho in the insurance at the time. He suggested I was old enough to move on. Really? Duh. Ok rantoff. :) Quote Link to comment Share on other sites More sharing options...
Pamela H in Texas Posted June 28, 2010 Author Share Posted June 28, 2010 Thanks y'all. I appreciate the help. Quote Link to comment Share on other sites More sharing options...
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