sean48•10d ago

Debate: Is it better to pay more upfront for a PPO or gamble with a high deductible HMO?

I had a heck of a week in March when I needed an MRI for my knee... my HMO plan through the marketplace wanted me to wait 3 weeks for an appointment at a specific imaging center 45 minutes away. But my buddy with a PPO got one the next day at the place down the street for only $150 more out of pocket. On one hand, the HMO saved me $80 a month in premiums, but on the other hand, that wait cost me a week of work. What do you guys lean toward when you're picking plans during open enrollment?

4 comments

4 Comments

thomas.river10d ago

Actually, HMO copays for multiple specialist visits can add up way faster than just hitting one PPO deductible.

hunt.hayden10d ago

Oh man, I think one thing people miss is how the HMO might actually save you money if you're someone who uses a LOT of specialists - like if you have a chronic thing, the lower copays can really add up compared to hitting a PPO deductible over and over. Idk, it's like you gotta guess how much you're gonna get sick that year and that's the real gamble.

noahwood10d ago

@thomas.river makes a solid point though, my buddy had an HMO last year and the copays for his three specialists legit cost more than just paying the PPO deductible once lol. It really is just a guessing game like you said, pick your poison.

adam18610d ago

Actually run the numbers on your specific meds and doctors before open enrollment ends. Grab your EOBs from this year and add up what you actually paid with copays and coinsurance. I've seen cases where someone with diabetes or thyroid issues ends up way ahead on an HMO because those regular blood tests and endocrinologist visits add up fast on a PPO. But it flips if you need like one surgery or an MRI, those get capped at the PPO out-of-pocket max and you're done for the year. Just depends on if you're spreading costs out or hitting a big expense all at once.