After attending an informational session on your company's health-care plan offerings, you are still unsure about the right plan to select. Your company offers employees the choice to participate in a preferred provider organization (PPO) plan or a health maintenance organization (HMO) plan. You are currently enrolled in the PPO plan, but after learning more about the HMO at the session, you are considering changing to the HMO plan. This is an important decision, as the plan you select will provide the health coverage for you and your family. While you are satisfied with the PPO, it seems that selecting the HMO could lower your health-care expenses.

Under the company's current PPO plan, you have access to a network of doctors and pay a lower copayment and deductible if you go to doctors within the network. However, if you do need to see a doctor who is not in the network, you are still covered by the plan, but at a higher cost to you. You have enjoyed the flexibility of the PPO option and have developed 164relationships with some specific doctors within the network. For example, you see an allergist who treats your allergy problems. Further, you have taken your children to the same pediatrician since they were born. While the children do not have any chronic health issues, you have a trusted relationship with the doctor and are hesitant to make a change.

Now, as you examine your options, you find that the HMO offers some features that could provide you with a cost savings. The cost of the monthly premium that you would pay for the HMO to cover you and your family is lower than the premium that you pay for the PPO. Further, while you would still pay copayments for office visits and other services, you would not have the deductible and coinsurance that you currently pay with the PPO. However, with the staff model HMO option that your employer is offering, you could only see the doctors employed by the HMO. Further, you would need to select a primary care physician whom you would need to see before you could see a doctor who is a specialist, such as an allergist.

The flexibility of the PPO was very attractive to you, and you are unsure if you are comfortable with the limits of the HMO. However, the cost savings may make it worthwhile to pursue the HMO. You have to make your decision next month, during the company's annual open enrollment period. As you sit down to review the materials, you are not sure what you should do.

2. What are some advantages and disadvantages of the HMO to you?
4. What should you do? What are factors that will influence your decision?

Answer rating: 100% (QA)

HMO Advantages and Disadvantages Advantages Lower Cost Generally HMO plans have lower monthly premiums no deductibles and potentially lower copayments ... View the full answer