MA HMO or PPO??
- Thread starter rousemark
- Start date
- 29,491
You have more freedom with a PPO. You can go outside the network, but will have to pay a higher copay or % of the bill.
- 16,884
HMO is more of a managed care plan. Its better for people that want they GP to run the show and to select all their care and specialists. You have no coverage if you go out of network unless emergancy.
PPO you have more independence to do what you want. But you have yo be careful to try not to ho out of network or you will sometimes pay much higher co-pays and out of pocket costs.
HMO will deny non-par claims unless it is a life threatening emergency.
PPO usually has a higher copay and higher OOP for non-par providers. Non-par providers will generally have to sign a contract saying they are willing to accept payment from the carrier
Both may require step therapy for new brand name drugs . . . both may require pre-authorization for expensive tests and/or procedures.
PPO usually has a higher copay and higher OOP for non-par providers. Non-par providers will generally have to sign a contract saying they are willing to accept payment from the carrier
Both may require step therapy for new brand name drugs . . . both may require pre-authorization for expensive tests and/or procedures.
Usually much higher for things other then Doc visit
I try and explain so people understand just because its only $10 more to so out of network doc, That test he takes or the surgery could be much higher 40% in many cases
- Thread starter
- #7
Was looking at the new Humana MA plans.
If your providers are in the HMO, go HMO. Make an appointment with your PCP for the first week in January, NOW. (Even if you don't switch, you can keep the appt) Let the office know you are making the switch for 1/1 and to get the referrals moving on January 2. Going HMO will limit your OOP responsibility. Enroll on 10/16, so you have your ID number before Thanksgiving.
If you want the flexibility for out of network providers, go PPO, but you just doubled your OOP exposure and its probably more than you are paying on your Medicare Supplement, so you gain nothing there.
And all of this assumes your drugs are ok under Humana for 2023.
You also need to make sure your loved ones understand the change, so they know that its no longer "everything is covered and we don't have any bills coming in"
Hang in there !
- Thread starter
- #10
Thanks... I really am having a hard time ,aking up my mind to switch. Counting my PDP I am paying $4450 for my Med Supp. Wish we had a birthday rule in TN. I like choosing any provider I want to use, with no prior authorizations or referral requirements.
