HMO vs. PPO: Why I choose to pay more for health insurance


Our company has hit us with the news that our premiums for health insurance are going up this year. We currently have a PPO plan, and I have the choice to elect to go for the cheaper HMO option. However, despite the significant increase in health insurance premiums, I am choosing to pay more for health insurance and the main reason is flexibility.

For an HMO plan, to cover my husband and me, would cost $15. It’s honestly one of the best values. $15 a month for medical insurance? You can’t beat it. However, the first year I worked here, we went with the HMO option and it was absolute misery. It took months to get an appointment, and when  I finally made an appointment, I barely had a moment to breathe and the doctor was gone.

When I wanted to see a specialist, I had to call up and make another appointment with a primary care physician and then wait again to make an appointment with a specialist that they recommend–I can’t choose my own. So it would take months to get an appointment with a specialist.

This past year, it was actually cheaper to go with the PPO plan than the HMO plan. SO I made the switch. And I honestly think someone in the big blue sky was watching out for us, because this was the year we practically maxed out our deductible.

In late March, my husband ended up getting injured in a soccer game. This turned into a trip to the emergency room and a few specialist office visits. Had we had an HMO, visiting the specialists would not have been an option, unless we wanted to pay an exorbitant amount in extra costs.

I was grateful at the time that we had elected the PPO coverage. And don’t get me wrong, we still paid several hundred dollars out of pocket. I think in total with the emergency room visit and specialized doctor’s visits, we probably spent about $1,000 out of pocket–but we had the peace of mind that my husband got the best care possible. And there’s no price that can be paid for peace of mind.

This year, our health insurance will go from $71 to $120 a month for coverage. The $15 HMO plan is starting to look real good right about now. However, with our flex spending account (FSA) going down from the $5,000 max in 2012 to the $2,500 max in 2013 because of Obamacare, we really won’t feel much of a difference in take-home pay.

I would rather stick with our full service health care plan that allows us to make specialized visits in cases of emergency, and also for routine care, such as my dermatology appointments. I also like that I can visit my regular doctor, and we chat for more than 30 seconds.

Since we won’t really notice a change in take home pay, it’s worth it to me to continue to pay more for health insurance. It’s almost like investing in your 401K–you forget that you’re making the financial contributions because it’s automatically deducted from your paycheck, and yet you’re still making a big investment in yourself.