What would you do? Insurance question

I recently landed a state government job, and my wife has a federal government job.

I was comparing the cost of health insurance for each.

Which would you choose:

HMO style plan (need primary doctor to give referral to specialists) for $105/mo for the family.


I can choose whatever doctor I want for $400 per month for the family.

For the most part, coverage levels are so similar that it can be considered irrelevant.

But, both my endo and my wife’s ob would be considered specialists.


As much as I despise the need for referrals, the cost is a huge difference. Are there huge differences in copays for specialists v. PCP? Are all other copays the same? What tiers are your meds in? If the overall costs will be less if you go for the $400/mo one, go for it, but the hastles of referrals might not be worth it. My PCP gave me her “code” so I could do my own endo referrals when I was starting the pump and needed stacks of them!

Generally, all other costs are equal.

Copays, coinsurance, and scripts would all be about a wash.

Go for the cheaper, absolutely then. My current insurance is PPO, not HMO so I dont’ need referrals, which has been nice, but the 20 mins/ month I spent max on phone calls for referrals would not ever be worth nearly $300/ month.

In California, my Blue Shield HMO has “medical groups”. If I want to see one specialist in one medical group and another specialist in another medical group, I cannot. I have a primary care physician that is working with me on my diabetes, because I hate the two endo’s that are offered and I love my nephrologist. Call their offices and verify they take your HMO plan before you commit to it.

I would personally pay an extra $300 per month to be able to see whatever physician I want to, assuming there are really no restrictions. If you can see the specialists you love with just an extra office visit to a PCP, save the money.

Another thing to consider is on the plan choices I have as a California government employee is out of pocket expenses that would really add up for someone like me, or for catastrophic expenses. Like I pay $50 for an ER visit unless I am admitted, and then I pay nothing. I was unexpectedly hospitalized a couple of years agofor 12 days, It didn’t cost me a penny, but on the other plan I would have paid $100/day. Not a ton of money, but I also couldn’t work for about 4 months, so every penny counted.