Should you enroll in a HMO (health maintenance organization) like Kaiser, or a PPO (Preferred Provider Organization)?
The question comes up a lot, because they are very different plans.
They main differences come down to freedom of choice and back end costs.
Freedom of choice:
HMO: You are assigned a primary care doctor in the HMO network. You have to stay in network, except in cases of emergency.
PPO: You can choose doctors, hospitals, and other providers from the PPO network or from out-of-network. If you choose an out-of-network provider, you most likely will pay much more.
Back end costs:
HMO: Usually cover most back end cost, depending on the plan
PPO: Cover only a amount, requiring you to pay 5-30% of covered procedures
Up front costs:
HMO: A higher premium but often no deductibles and low co-pays
PPO: A lower premium but large deductibles and varying co-pays
I personally have Kaiser HMO because I have been burned by the back end fees with PPOs. Yes it is more money per month, but I've already had two expensive procedures that would have been $30,000 plus out of pocket uninsured and I would have hit your $3000 at least twice with a PPO and it's associated deductible(s), so I've come out ahead with Kaiser.
Another thing about Kaiser HMO, they are very efficient. That means a doctor will come in, address the reason you made your appointment, write a script or not, then move onto the next patient. If you have something else wrong with you that you forgot to mention when you called to schedule your appointment, some doctors will go over it, other's will say "make another appointment." Esp. if they have many people waiting. If you are busy you should appreciate that wham bam approach.
With a PPO, the doctor would sit and chat, since you are more of the "customer" and paying for more of the coverage out of your own pocket.
I have Kaiser's most expensive plan. It depends more on your health history and lifestyle. Are you a daredevil, engaged in a dangerous sport or occupation? If so, you probably already get injured a lot. Then go with the Kaiser HMO.
Caveat: If there is a Doctor that you really like, assuming you've been on a PPO for awhile, you can forget about him treating you under an HMO. It most likley won't happen.
Craig Casey is an Writer, Coach, Blogger, Husband, and Former Health Insurance Agent helping people on the web since 1999 with their health insurance problems.
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