Health Care Plans - HMO vs PPO etc

[kristammmkay]

For those US citizens -

I would also like to ask all of you with Individual direct (not through employer) HEALTH CARE PLANS (non-Medi-Cal/Medi-Care eligible) - what are your thoughts about your Health Insurance plan or others you have tried? Do you like your health insurance? Do they cover anything extra like acupuncture/chiro/massage? If so I'd LOVE to hear about it. Only have 2 months to decide my health for the next year. EEK!

I'd appreciate hearing all of your experiences good and bad, regardless of state, as a lot of health insurance companies are nationwide and plans only vary a little by state. (I live in California)

I am currently with an HMO plan and am torn on whether to switch to a PPO with higher premiums and deductibles, or stick with my HMO and be stuck fighting for my rights all next year.

Have any of you filed appeals with your insurance company? I'd love to hear your experience with that as well, as I am currently in the process of appealing to receive acupuncture under my health insurance.

Thanks
Krista

[gurs]

Its very confusing...I tend not to go with HMO's because alot of my docs are not in the networks, and they also need alot of pre-approval for tests etc. It depends on costs and what you can afford as well. My BCBS plan is a PPO and I love it. It covers everything. I only paid 122.00 a month for the last 5 years, but now it will be 314.00. I thought it was high, but after calling around to different companies and talking to some others, its not that bad.

Hope you can find something that works.

Gursie

[warmwaters]

While I'd like to help, I find that it's very hard to compare. Each insurer has so many different plans both in terms of deductibles, co-pays, and coverage that I could tell you my insurer is great, but maybe it's because I picked the super deluxe plan. You might pick a different plan from the same insurer, or be in a different state, and have a different experience.

There is service that rates plans, and you can look at plans in a particular state.
http://healthinsuranceratings.ncqa.org/2016/Default.aspx

That might be a good place to start.

HMO vs PPO is tricky. There are some great HMOs out there that really do provide all the services in house. And there are some lousy ones that make it very hard to get the care you need. PPOs can be great if they have a big network, but if you don't have your doctors in their network, then it's an issue. And some PPOs have lousy networks.

The way I researched health insurance was to list the doctors I was seeing, the kinds of services I had in past year (X-rays, tests, whatever), and then see if I could see those doctors and get those services on the new plan. And roughly estimate what the costs would be.

To me cost is Premium + deductibles + copays +out of pocket

[kristammmkay]

Thanks!

Warm Waters - what insurance provider do you have? PPO or HMO? I have done plenty of research and have a costing sheet going but I was hoping to get some individualized feedback about companies (in addition to the HMO vs PPO aspect)

Of course it depends on the individualized costs but wanted to hear from you guys cause I imagine most people in this group need alot of health care coverage and rxes, as do I.

Then there's the topic of alternative health care through insurance, and if any of you have thoughts / experiences on that I'd love to hear as well.

It's not so much that I am looking for one answer from one person, but I'd really like to hear from whoever is willing to share what your personal experience has been with your health care, who your provider is, if you have HMO or PPO, what your monthly premiums/ deductibles are, and what metal level you went with.

I of course plan on doing my own due diligence before selecting a plan but I was hoping to hear some horror stories from bad companies and some rave reviews regarding the ones people have positive experiences with, to maybe narrow down my scope a little and avoid getting entangled for a year with a crappy company.

Thanks
Krista

[warmwaters]

I am actually on Medicare these days (for disability), though I still have to figure out prescription drug plans each year. My last year of insurance was back in 2011, and things have changed since then.  Sorry.

[SjoDry]

Krista,

I have a PPO. I am not supposed to mention my blog on this forum..but rather than me launch into everything I just wrote in my last blog post..I will refer you to my signature line where you will see the name of my blog.

My last post was totally about my PPO insurance experience. Aside from my blog post details, I will say that the PPO itself was effective in and of itself. If you have any questions, please feel free to message me.

SjoDry