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the difference in the premium is pretty big. Can anyone tell me why this is? We are probably going with the PPO plus, but I was just curious.
And BTW, if we do go with one of the PPOs, does this mean we have the option of seeing docs in MA
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I think you hit the nail on the head. The premium is higher because your out of pocket costs are lower. The price of choosing a PPO is that you have to pay a deductible and then a percentage of your care. We have BCBS PPO Plus and we have to pay 10% doctor visits, 20% in patient hospitalization, 10% for out patient tests such as MRIs or blood tests. I think drug costs are the same for both HMO and PPO, we pay 40% for meds unless it is mail order, then we pay 25%. One drug I take is considered "rare" and they let me pay only 10% if I order mail order every month. But, even at 10% it costs me $276/ mo. There is a max out of pocket cost for medical (not drugs) set at $5K/ yr for us. BUT, your company may have different limits. Every company is different.
Despite all these higher costs, I still think going PPO Plus was the best for us because we can go anywhere and have as many second opinions that we want. There is a big list of doctors and hospitals that are preferred which means that they will accept what BCBS will pay them and you don't have to pay the difference. And, even though you can go out of network, you have to pay the difference between what they charged and what BCBS will pay them, which is HUGE. For instance, my husband just had out patient surgery. One of the bills was for approx $4300. BCBS paid them $1800. Now, we only have to 10% of that $1800. If they were out of network we would have to pay the 10% PLUS the difference of $2500. Honestly, I don't know if that difference goes toward your yearly max because every doctor that we ever wanted to see was in their network. His surgery was at Tufts while we live in NH, so yes, you can go to MA hospitals and doctors. You can go to CA hospitals or see WA doctors while living in NH if you like because they would probably be in the national BCBS plan's network.
I mentioned the national network because our BCBS plan is based in Dallas because that's where my husband's company headquarters is. We have used the same cards in IL that we are using in NH. I was told that as long as the doctors are in any BCBS PPO network, we can use them throughout the US.
I'm not saying that all HMOs are bad. When I carried our medical coverage in PA, I had an HMO. My daughter who was 9 months old became seriously ill. She was sent to a children's hospital in Philly. Her hospitalization there cost over $110,000 21 years ago and she needed daily blood tests and other treatments after discharge for almost 2 years afterwards. My total out of pocket cost was $30 which included the hospital, tests, & doctors in patient and out patient for 2 years. Something about the way coverage was written, I didn't have to pay my doctor co-pay for specialists and had $0 copay for the tests and hospitals too. Of course, since I had left that job 18 years ago, the HMO coverage through 3 different companies, including Cigna, we had in AZ, NC, and NM sucked.
I think I would only recommend HMO to a single person who is under 40 and has no medical problems.