(2017-04-19) HMO vs PPO

There are plenty of blog posts explaining how HMOs and PPOs vary. But I just put together some practical notes, so thought they'd be worth sharing. The details certainly vary from plan to plan, but the ratios are probably pretty similar....

Premium ~same to us either way

• company is paying (other) half

with HMO MD/everything must be in-network

• no deductible for anything
• annual/well is free
• PCP $25
• Specialist $55
  • have to go through PCP to get specialist
• labs, xrays: $0
• hospitals, etc.: 20%

with PPO can be out-network but more expensive

• note our PPO network is bigger than HMO network
• in-net
  • annual/well is free; preventive care is free
  • PCP visit $20 (no deduct)
  • Specialist $35 (no deduct)
  • labs, xrays: deductible ($1k ind, $2k fam), then 20%
  • hospitals, etc.: deductible, then 20%
• out-net (everything)
  • you pay full (discounted) rate until deductible ($2k ind, $4k fam), then 50%