Medical and Dental Insurance question

jbmagic · 10-01-2005, 12:30 AM

whats better for Medical Insurance?

Bluecross HMO health plan, Kaiser Permanente HMO or Blue Cross PP0?

what better for dental insurance?

Delta Dental DPO, Delta Dental PMI or Dental Delta Preventive only?

digamma · 10-01-2005, 08:13 AM

Depends on your limits co-pays etc., but I always prefer a PPO over an HMO.

Ksyrup · 10-01-2005, 09:00 AM

PPO is better, but if your employer requires you to contribute to the cost, it will undoubtedly be more expensive. If the cost is equal, take the PPO. It's basically the difference between being forced to go to certain doctors and having the choice to go to whomever you want.

BYU 14 · 10-01-2005, 10:53 AM

PPO is usually always quite a bit more in terms of what you have to contribute towards the premium. You will also have a higher out of pocket cost for Medical services incurred outside of a Doctors office (ER, outpatient Hospital services etc) The tradeoff of course is the Freedom you have.

Working in the industry I can tell you Kaiser does not have a great rep and would not even enter into consideration for me. I would pick between the blues, then you just have to ask yourself what your needs are.

If you have Kids an HMO is probably better, though you will be constrained in your cnoice of care, having to go through your PCP for referrals, waiting for HMO approval for none emergency services etc. But, Kids can incur a lot of minor illness/injuries and the savings might offset the lack of Freedom.

If you don't have Kids and can afford the extra Premium, or if you just like to manage your own healthcare, see specialists when you want to, go out of network if you want to etc, then go with the PPO as the premium for one person will not break you.

Another thing to keep in mind...Check the Provider lists for both, see if your favorite Doctor(s) are participating. If you take PPO you can see a Doctor outside the Network and still get a reduced benefit (Usually a higher copay or higher Deductible and Coinsurance) On the HMO you get no benefits paid to non-particiapting Doctors unless it is an extreme emergency or a very rare situation where you can't get adequate care from a network Doctor (In both of these cases you have to jump through a ton of hoops and there is still no guarantee of an exception with HMO's)

These are all the key points to consider IMO.

Rizon · 10-01-2005, 10:56 AM

I think the difference is PPO= Please Pay Or else and HMO = Have Money Or else.

Seriously though, depends on how much your employer pays and what the co-pay is. Probably for your age and a $5 co-pay, Kaiser would be like $240/mo. The higher the co-pay the less you pay per month (but the more you pay per visit, and not all things are covered with higher co-pay plans).

Same with the dental. Most companies offer a shitty dental plan though. But my wife had Delta Dental through GAP, and they covered something like 80-100% at about $8/mo (Not sure, its been awhile). It was an awesome plan. In fact, I waived mine at work and had them up my pay and had my wife add me to her dental plan.

You have to compare them all side-by-side ... either you pay alot per month or you pay alot per visit. Which risk is worth it to you? For me, I'd rather not get butt fucked if something goes really wrong, in exchange for a small fingering each month.

Rizon · 10-01-2005, 10:57 AM

PS: If you like Motrin, go with Kaiser. They love to prescribe that shit.

Rizon · 10-01-2005, 11:00 AM

PSS: Wiki explains what a PPO and HMO are

hxxp://en.wikipedia.org/wiki/Preferred_provider_organization
hxxp://en.wikipedia.org/wiki/Health_maintenance_organization

jbmagic · 10-01-2005, 11:16 AM

thanks guys.

looking over the plans at my work. Medical benifits is free no deductable taken out of my pay check for hmo or ppo to cover me only.

same for my dental plan for PMI and DPO its free no deductable taken out of my pay check to cover me only.

For dental whats better Delta Dental PMI or DPO?

gstelmack · 10-01-2005, 12:00 PM

PPO. My one HMO experience was absolutely abysmal. I currently have a Blue Cross PPO (here in North Carolina) and it's been pretty good. They respond to claims fairly rapidly, and were really great with my wife's pregnancies and the complication she had after the last one.

CraigSca · 10-01-2005, 12:57 PM

Isn't this what HR is for?

jbmagic · 10-01-2005, 01:03 PM

for a guy that dont go to the doctors a lot i probably better off with HMO right?

plus my doctor i want is under hmo and pmo

plus most things are 100% cover on hmo and lower copayment and PMO shows most things 90% cover and higher copayments

cthomer5000 · 10-01-2005, 01:54 PM

Quote:

Originally Posted by CraigSca

Isn't this what HR is for?

FOFC can do it all!

gstelmack · 10-01-2005, 02:41 PM

Quote:

Originally Posted by jbmagic

for a guy that dont go to the doctors a lot i probably better off with HMO right?

Possibly. The key is when you DO get sick, you're unlikely to be able to have much choice in who treats you, so it's a bit of a gamble. In my case, I lost that gamble, got an old fogey who took blood and urine samples and said he'd call with the results in 2 weeks. Since I was feeling so lousy I wasn't sure I'd be ALIVE in 2 weeks, I sought alternatives.

Quote:

Originally Posted by jbmagic

plus my doctor i want is under hmo and pmo

plus most things are 100% cover on hmo and lower copayment and PMO shows most things 90% cover and higher copayments

HMO is less out of pocket, but you lose choice. They'll send you to who they want to send you to. And remember, because they cover everything, they often take the cheaper route. It's your call. I just know I'll never be under an HMO again if I have any kind of a choice, no matter how much more it costs me. My health is one of those things I'm not going to be cheap on.

lynchjm24 · 10-01-2005, 09:21 PM

1. The first thing to consider is plan designs:

The keys are:

Deductible
Coinsurance Percentage
Coinsurance Limit
Office Visit Copays
Specialist Visit Copays
Pharmacy Copays

The PPO will have in and out of network benefits, the HMO will only have in network benefits.

2. Then you need to consider the contributions:

If you don't have anyone else to cover, then it comes down to the plan design, otherwise there is going to be a huge cost to cover your dependents.

3. Next, your age and current health would be a factor

4. Finally where you live and how deep the HMO and PPO networks are.

Don't listen to all of the doom and gloom about HMO's. There are many different kinds, and you can still have plenty of choice depending on how your employer set things up.

As far as dental goes, the plan design is really the key - and what you might think you'll have done in the next 12 months. I believe the PMI plan is Delta's Dental HMO. Most Dental HMO's have very shallow networks, since the services are very highly discounted, most dentists don't wish to participate. If you need a lot done and can find someone in the provider list that you could go to the dental HMO might be a good idea because they typically don't have yearly maxes like a dental PPO (DPO) plan does.

10-01-2005, 09:00 AM	#3
Ksyrup This guy has posted so much, his fingers are about to fall off. Join Date: Nov 2000 Location: In Absentia	PPO is better, but if your employer requires you to contribute to the cost, it will undoubtedly be more expensive. If the cost is equal, take the PPO. It's basically the difference between being forced to go to certain doctors and having the choice to go to whomever you want. __________________ M's pitcher Miguel Batista: "Now, I feel like I've had everything. I've talked pitching with Sandy Koufax, had Kenny G play for me. Maybe if I could have an interview with God, then I'd be served. I'd be complete." Last edited by Ksyrup : 10-01-2005 at 09:01 AM.

10-01-2005, 11:16 AM	#8
jbmagic Pro Starter Join Date: Apr 2004	thanks guys. looking over the plans at my work. Medical benifits is free no deductable taken out of my pay check for hmo or ppo to cover me only. same for my dental plan for PMI and DPO its free no deductable taken out of my pay check to cover me only. For dental whats better Delta Dental PMI or DPO? Last edited by jbmagic : 10-01-2005 at 11:23 AM.

10-01-2005, 12:00 PM	#9
gstelmack Pro Starter Join Date: Oct 2000 Location: Cary, NC	PPO. My one HMO experience was absolutely abysmal. I currently have a Blue Cross PPO (here in North Carolina) and it's been pretty good. They respond to claims fairly rapidly, and were really great with my wife's pregnancies and the complication she had after the last one. __________________ -- Greg -- Author of various FOF utilities

10-01-2005, 12:57 PM	#10
CraigSca Pro Starter Join Date: Jul 2001 Location: Not Delaware - hurray!	Isn't this what HR is for? __________________ She loves you, yeah, yeah, yeah, yeah! She loves you, yeah! how do you know? how do you know?

10-01-2005, 01:03 PM	#11
jbmagic Pro Starter Join Date: Apr 2004	for a guy that dont go to the doctors a lot i probably better off with HMO right? plus my doctor i want is under hmo and pmo plus most things are 100% cover on hmo and lower copayment and PMO shows most things 90% cover and higher copayments Last edited by jbmagic : 10-01-2005 at 01:04 PM.

10-01-2005, 08:13 AM	#2
digamma Torchbearer Join Date: Sep 2001 Location: On Lake Harriet	Depends on your limits co-pays etc., but I always prefer a PPO over an HMO.

10-01-2005, 10:53 AM	#4
BYU 14 Coordinator Join Date: Jun 2002 Location: The scorched Desert	PPO is usually always quite a bit more in terms of what you have to contribute towards the premium. You will also have a higher out of pocket cost for Medical services incurred outside of a Doctors office (ER, outpatient Hospital services etc) The tradeoff of course is the Freedom you have. Working in the industry I can tell you Kaiser does not have a great rep and would not even enter into consideration for me. I would pick between the blues, then you just have to ask yourself what your needs are. If you have Kids an HMO is probably better, though you will be constrained in your cnoice of care, having to go through your PCP for referrals, waiting for HMO approval for none emergency services etc. But, Kids can incur a lot of minor illness/injuries and the savings might offset the lack of Freedom. If you don't have Kids and can afford the extra Premium, or if you just like to manage your own healthcare, see specialists when you want to, go out of network if you want to etc, then go with the PPO as the premium for one person will not break you. Another thing to keep in mind...Check the Provider lists for both, see if your favorite Doctor(s) are participating. If you take PPO you can see a Doctor outside the Network and still get a reduced benefit (Usually a higher copay or higher Deductible and Coinsurance) On the HMO you get no benefits paid to non-particiapting Doctors unless it is an extreme emergency or a very rare situation where you can't get adequate care from a network Doctor (In both of these cases you have to jump through a ton of hoops and there is still no guarantee of an exception with HMO's) These are all the key points to consider IMO.

10-01-2005, 09:21 PM	#14
lynchjm24 College Benchwarmer Join Date: Jan 2003 Location: Hartford	1. The first thing to consider is plan designs: The keys are: Deductible Coinsurance Percentage Coinsurance Limit Office Visit Copays Specialist Visit Copays Pharmacy Copays The PPO will have in and out of network benefits, the HMO will only have in network benefits. 2. Then you need to consider the contributions: If you don't have anyone else to cover, then it comes down to the plan design, otherwise there is going to be a huge cost to cover your dependents. 3. Next, your age and current health would be a factor 4. Finally where you live and how deep the HMO and PPO networks are. Don't listen to all of the doom and gloom about HMO's. There are many different kinds, and you can still have plenty of choice depending on how your employer set things up. As far as dental goes, the plan design is really the key - and what you might think you'll have done in the next 12 months. I believe the PMI plan is Delta's Dental HMO. Most Dental HMO's have very shallow networks, since the services are very highly discounted, most dentists don't wish to participate. If you need a lot done and can find someone in the provider list that you could go to the dental HMO might be a good idea because they typically don't have yearly maxes like a dental PPO (DPO) plan does. Last edited by lynchjm24 : 10-01-2005 at 09:25 PM.

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