Should I switch from a PPO to HMO? Help, please!

[Anonymous]

We've been on my employer's Aetna PPO for a few years (DH, 2 y/o, and I). It is expensive, the coverage isn't fabulous, and having my daughter was VERY expensive. We're looking to TTC again and I'm thinking of switching to the Aetna Open HMO. The monthly premiums and OOP would be much better, and all of the doctors we currently see accept both plans. But I don't know anyone that's made the switch from a PPO to HMO, my HR is no help, and I'm nervous that I'll regret it, especially if we do get pregnant this year. Has anyone switched from a PPO to HMO? Did you love it or regret it? What should I consider before making the decision?

[Anonymous]

I don’t have much experience to share, but I’m doing the same thing. I’m a Fed and in this open season I’m switching from BC/BS PPO to Aetna Open Access. Our doctors are all network doctors and not having to get a referral to specialists did it for me. Saving about $200 a month in premiums.

If you aren’t crazy about it after a year, can you change back to a PPO?

[Anonymous]

I had an hmo when I got pregnant (in October of previous year); it was annoying to have to go to my pcp before getting a referral to an ob. There are already so many appointments for pregnancy, it was a stupid one to have to go to for pretty much no reason. (It wasn’t just the appt. it caused an unrelated-to-this-discussion insurance claim issue and dealing with several phone calls about that too). Just for me to get an OB referral.

Anyway baby was born under a ppo bc I changed my insurance at the new year. It was SO GREAT, because I had complications and saw a few other specialists after the birth. I’m glad to didn’t have to go through my pcp for those appointments.

Now, we have a simple year ahead, I hope, and I’m considering saving a few hundred dollars/month and going back to an hmo. Still annoying and potentially costly, but I think the savings could be worth it for us. I’m hoping we don’t need to use insurance much anyway!

[Anonymous]

Thanks, PPs. This HMO doesn't require a referral, so I think that annoyance wouldn't be an issue. I did have complications with my first pregnancy and birth, so I think I'm extra nervous that some random specialist that could be called in would be out of network. Unless things happen much faster this time, I'd likely be delivering in the following year, so I guess I could try it and switch back to the PPO if I don't like it.

[Anonymous]

Does your family have any health issues? If yes, i wouldn't switch. Things will rise unknowingly of course but i we don't have a health condition, any plan is as good as the other.
But, if you are worry about getting pregnant and delivery. Maybe just wait till April to start really planning for baby 2. That way, the baby won't come till 2019! You can change back during open season.

[Anonymous]

I had an HMO (Kaiser) for my pregnancy and delivery and thought it was great. It really cut down on the decisions I had to make, and the administrative stuff was almost nonexistent. Cheap, too.

You may have to be comfortable with the idea that you are unlikely to have "your" doctor delivering your baby. During my pregnancy, I saw nearly every member of their OB/GYN team at prenatal visits. I was in labor for a long time (26 hours) so 3 doctors were on shift during my labor. The first guy was new to me and so great I really wanted to have my baby with him. No luck. He went off shift and then the guy we called "Dr. DoucheBro" came on shift. My partner and I agreed that I didn't want him delivering my baby, and joked about holding it in until he was off shift. He left. Doctor #3 came on. I was not super excited about him either - I had seen him during the pregnancy and thought he was kind of meh. He ended up doing the delivery and he was great. His bedside manner was on the reserved side, but I couldn't fault anything else. A friend later told me he was her longtime OB/GYN and she adored him, so different strokes for different folks.

[Anonymous]

Anonymous wrote:Does your family have any health issues? If yes, i wouldn't switch. Things will rise unknowingly of course but i we don't have a health condition, any plan is as good as the other.
But, if you are worry about getting pregnant and delivery. Maybe just wait till April to start really planning for baby 2. That way, the baby won't come till 2019! You can change back during open season.

Thanks, OP here. No major health conditions and DH's allergist (he's getting allergy shots) takes the HMO as well. What was really annoying with the PPO was that tests and ultrasounds were covered at 85%, so I was constantly writing $100+ checks for ultrasounds, blood work, and other routine testing. Then I ended up being in the hospital for almost a week and the baby needed the NICU and specialists, so the delivery and postpartum care was really expensive. I'd like to avoid the next pregnancy costing $5,000-10,000, but not if it limits the care or providers we have access to.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Does your family have any health issues? If yes, i wouldn't switch. Things will rise unknowingly of course but i we don't have a health condition, any plan is as good as the other.
But, if you are worry about getting pregnant and delivery. Maybe just wait till April to start really planning for baby 2. That way, the baby won't come till 2019! You can change back during open season.

Thanks, OP here. No major health conditions and DH's allergist (he's getting allergy shots) takes the HMO as well. What was really annoying with the PPO was that tests and ultrasounds were covered at 85%, so I was constantly writing $100+ checks for ultrasounds, blood work, and other routine testing. Then I ended up being in the hospital for almost a week and the baby needed the NICU and specialists, so the delivery and postpartum care was really expensive. I'd like to avoid the next pregnancy costing $5,000-10,000, but not if it limits the care or providers we have access to.

Then that’s a bad ppo. I had a baby 2 years ago and a nicu stay etc and pretty much paid for nothing.

[Anonymous]

Switched from DH’s BCBS PPO to my BCBS hmo when I got a new job. Our responsibility was 10%. My csection at Inova cost us over $3k. 3 years later, another c section with the same OB, same hospital. We paid $250 for it. As long as your provider participates in the hmo, you’re good.

[Anonymous]

OP again - ok, I think you've convinced me to give the HMO a try. Thanks!

[Anonymous]

I'm comparing the Fed BCBS PPO and the Carefirst BlueChoice HMO (also BCBS network) does anyone have experience with them? I have a great PCP who would give me referrals over the phone- would it be worth trying the HMO?

[Anonymous]

Anonymous wrote:I had an hmo when I got pregnant (in October of previous year); it was annoying to have to go to my pcp before getting a referral to an ob. There are already so many appointments for pregnancy, it was a stupid one to have to go to for pretty much no reason. (It wasn’t just the appt. it caused an unrelated-to-this-discussion insurance claim issue and dealing with several phone calls about that too). Just for me to get an OB referral.

Anyway baby was born under a ppo bc I changed my insurance at the new year. It was SO GREAT, because I had complications and saw a few other specialists after the birth. I’m glad to didn’t have to go through my pcp for those appointments.

Now, we have a simple year ahead, I hope, and I’m considering saving a few hundred dollars/month and going back to an hmo. Still annoying and potentially costly, but I think the savings could be worth it for us. I’m hoping we don’t need to use insurance much anyway!

I was this poster. Just enrolled...in hmo!
It’s sure saving us s lot of money, which helps a lot as we are trying to finish off student debt. We’re going to do it for just one year and maybe switch back to ppo for the following. We’ll see.

For our referral situation, my strategy is to concentrate many of my appts in the spring/summer. So maybe it won’t be as much of hassle.

[Anonymous]

Anonymous wrote:I'm comparing the Fed BCBS PPO and the Carefirst BlueChoice HMO (also BCBS network) does anyone have experience with them? I have a great PCP who would give me referrals over the phone- would it be worth trying the HMO?

With carefirst the good thing is you don't need referrals, at least for in network specialists. It is called open access and I've never needed a referral for anything.

[Anonymous]

Anonymous wrote:We've been on my employer's Aetna PPO for a few years (DH, 2 y/o, and I). It is expensive, the coverage isn't fabulous, and having my daughter was VERY expensive. We're looking to TTC again and I'm thinking of switching to the Aetna Open HMO. The monthly premiums and OOP would be much better, and all of the doctors we currently see accept both plans. But I don't know anyone that's made the switch from a PPO to HMO, my HR is no help, and I'm nervous that I'll regret it, especially if we do get pregnant this year. Has anyone switched from a PPO to HMO? Did you love it or regret it? What should I consider before making the decision?

We have an HMO through the feds. UnitedHealthCare. They have been great for years, but my husband was recently injured and they won't cover acute rehab for him. According to the hospital case managers, its regular practice for them to deny coverage for this level of care. And we have no options to even get a partial reimbursement for out of network costs. So that rots. But that may be specific to UnitedHealthCare.

For all other things, it's been fine. No issues. And it is cheaper than a PPO for sure.