Can you help me think through this?

[Pamela H in Texas]

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.

[Pegasus]

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

[Pamela H in Texas]

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.

[KnitWit]

Do you have the available cash to choose a plan with a deductible? If you do, I'd choose the deductible

[Garga]

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.

[Scuff]

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. :)

[Pamela H in Texas]

Thanks y'all. I appreciate the help.