Blue Cross Health Insurance: HMO or HDHP

Open enrollment is here and I am losing my PPO. Seems like I have to go HMO or High Deductable Health Plan. I’m newly Type 1. I’ve never been on an HMO, and am not sure it will allow me to get the care I’ve been having: A1C tests every 3-4 months, seeing endocrinologist every few months, regular podiatrist visits, etc. HDHP makes me pay for everything (RX, dr visit, labs) myself until I’ve paid $750 deductible, then pays 80%, but I could keep my current doctors: gp, endocrinologist, podiatrist, gyn, urologist.
Anyone out there have a good experience with HMO?

That seems strange that your ded is $750 for an HDHP. Generally HDHPs start at $1000 ded per individual and go up from there. My son who is T1D only qualified for a $5k hdhp through Blue Cross. They didn’t cover CDE meetings, yeah we could still go to the same Dr. but they didn’t cover any of it.

I don’t know if you are insured by yourself or have family, but we had to apply for new coverage for our whole family to get coverage for David on a PPO (good out weigh the bad sort of thing). I’m not too familiar with HMOs but the HDHP totally screwed us. If $750 is indeed your ded, I’d stick with it, that’s lower than our PPO ded!

My ded is really $1500, but my firm is kicking in $750 in a Health Savings Account, so I would only have to pay $750 towards the deductable.

I have Health Net HMO and it pays for all the above things. Only you can decide, but I don’t have thousands of dollars around for deductibles and 20% copays. That sounds very costly.

i suggest trying the HMO. Generally the knock on the HMO is that they do not allow choice of doctor. But, if you have to change anyway, you may find the HMO to be just as comfortable as any new doctor. Now, no matter, what choice you make, consider using your companies section 125 plan. These are sometimes called a cafeteria plan. The way it works is you set aside an amount from your check to pay for medical expenses. You set this aside form your check and federal taxes are not taken out on the amount withheld. You can then pay qualified medical expense using this money. Lets say you took the high deductible plan and withheld $750. From your check. Once the bills start to arrive you can be reimbursed form the dollars you withheld from your check. You get to spend these dollars, wihtout having hose dollars being subject ot federal withholding.

as an example:

say you withhold $1,000 and you are in the 15% tax bracket. The 15% tax bracket means you woudl normally receive $850.00. Using the section 125 plan all $1,000 is available for you to spend on medical bills, because you will obtain it without paying the 15%. the higher your tax bracket the better the deal, but it works at all tax rates . Regardless of what you choose, this will assit the new insurance plans. Ask your benefits person about it for full details.

rick phillips

Thanks for your suggestions–I went with the HMO–I plan on saving lots of money this year!