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You Down with PPO or HMO

First, I want to apologize to everyone for creating an earworm for the rest of the day and having you sing Naughty by Nature…not cuz I hate ya…anyway.

Since I am a newly married man, which it is still weird saying my wife instead of girlfriend or fiance, I am finally able to be put on her insurance.  I won’t officially be added for about a month because of the time it takes to get the marriage license, change her name, and then be added to the insurance.  Then, even after I am added to the insurance, I still don’t know how long it will take until I can actually use the insurance.  That’s the big question.

However, before that big question comes about, theres an even more important question, which plan do I choose?

When I was a single guy and had my own insurance, there was no question, I was going with the PPO plan.  Now, with having a spouse on the plan, it more than triples the monthly cost of the insurance premium (approx. $680/mo).  If I went with the HMO plan it is only approx. $225/mo.

So, obviously, this is where I need your help.  I was told in the past when I had to choose my first insurance plan with diabetes to never go with the HMO option. “If you have diabetes, you should always have a PPO”  I don’t know if that is the right advice or just some BS by that particular medical professional, who maybe wouldn’t be covered under the HMO plan.

Have you had any terrible nightmares with HMO plans with diabetes?  Is it really the worst insurance option for someone with diabetes?  HMO is still better than no insurance at all right?

Please let me know your thoughts and please share so I can make the most educated decision.  A difference of $4,000 a year is definitely a big deal.


2 thoughts to “You Down with PPO or HMO”

  1. Now this song will be stuck in my head all day… Thanks, Chris. 🙂

    But yes, good question. Really the big differences are cost and flexibility – HMOs are typically lower cost (as you’ve seen) in premium and also deductible. But you are restricted to basically being “in-network,” which really isn’t a problem if you only go to an endo or primary care and so on and don’t need a more flexible plan allowing you to basically see anyone. The real danger (in my opinion) is high-deductible HSA, which may be pitched as “more cost-effective” but for those of us living with chronic conditions can be a huge undertaking since we have to pay so much for our supplies and equipment up front. Anyhow, that’s my basic thought on it. PPOs are being weaved out as they do cost more to provide, so that might be something else to keep in mind – that eventually, you might be forced to change whether you want to or not. Good luck deciding!

  2. Please, please, please keep an eye on the dates. You have 30 days from the date of the marriage to be added to her plan. That is the enrollment period for a qualifying event (marriage). If it is a group plan your coverage should be immediate.

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