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State Employees: OGB HMO vs PPO?
Posted on 3/19/14 at 7:27 am
Posted on 3/19/14 at 7:27 am
Which do you use?
The HMO is cheaper but I'm having a tough time seeing a benefit going with the more expensive PPO
the HMO doesn't require a referral to see a specialist which is usually the biggest con for an HMO.
My wife's HR person automatically assumed we wanted the HMO which leads me to believe that's what most people choose.
The HMO is cheaper but I'm having a tough time seeing a benefit going with the more expensive PPO
the HMO doesn't require a referral to see a specialist which is usually the biggest con for an HMO.
My wife's HR person automatically assumed we wanted the HMO which leads me to believe that's what most people choose.
5
Posted on 3/19/14 at 8:29 am to Croacka
I like being able to pick my own doc and not have to go through a gatekeeper. I also had a personal experience with Humana a number of years ago that soured me on HMOs for life. My uncle, who lived in Florida, collapsed at his grandson's wedding in Houston. He was rushed to the hospital and eventually diagnosed with advanced bladder cancer. The man was in extremis but Humana wanted him to get on a plane and return to Florida so he could be treated in-network. frick HMOs.
Posted on 3/19/14 at 2:54 pm to Layabout
We are on OGB HMO as wife is a teacher and on state plan. We haven't had many issues, and all the doctors we've needed or wanted to see are on it. It's a big plan, so I guess that causes a lot of docs/hospitals to take it. Co-pays are very reasonable I think.
We did have a problem a few weeks ago with the pharmacy benefits. My youngest child had the luck to get the flu twice this flu season, once in November, and once last month. Doc prescribed Tamiflu both times. Second time, the pharmacy benefit didn't want to cover it, saying they will only cover Tamiflu once in a 180 day period. After about 45 minutes of talking my way up the supervisor chain, I finally got someone to approve it. Was about thisclose to just paying cash for it, but it's expensive!!
We did have a problem a few weeks ago with the pharmacy benefits. My youngest child had the luck to get the flu twice this flu season, once in November, and once last month. Doc prescribed Tamiflu both times. Second time, the pharmacy benefit didn't want to cover it, saying they will only cover Tamiflu once in a 180 day period. After about 45 minutes of talking my way up the supervisor chain, I finally got someone to approve it. Was about thisclose to just paying cash for it, but it's expensive!!
Posted on 3/19/14 at 3:16 pm to LSUFanHouston
I found most of our doctors on the list and apparently it somewhat converts to a PPO style when you are traveling, based on blue cross's PP list
Eta: wife is a teacher also, in LP
This post was edited on 3/19/14 at 3:18 pm
Posted on 3/19/14 at 5:55 pm to Croacka
HMO all the way! Me and my wife both have it through our state jobs and love it. We both had PPO before
Couple of years i had a pinoidal cyst removed and I had to pay over $2000 out of pocket for after insurance. It sucked meeting that deductible.
When my wife had our first kid she had PPO, it cost $1500 for the Dr visits plus $3000 during and after delivery, and then $500 on my insurance for his circumcision.
We have HMO now and we are have another baby and went to the Dr for the first time last week and all we have to pay is $20 insurance covers everything else.
It's great if you have kids it's just 15-20 a visit and wellness checkups are free. Plus ER visits are just $100.
Couple of years i had a pinoidal cyst removed and I had to pay over $2000 out of pocket for after insurance. It sucked meeting that deductible.
When my wife had our first kid she had PPO, it cost $1500 for the Dr visits plus $3000 during and after delivery, and then $500 on my insurance for his circumcision.
We have HMO now and we are have another baby and went to the Dr for the first time last week and all we have to pay is $20 insurance covers everything else.
It's great if you have kids it's just 15-20 a visit and wellness checkups are free. Plus ER visits are just $100.
Posted on 6/30/14 at 11:51 pm to Smokedawg
I searched so I'm bumping this thread
How much can I expect to pay per month for HMO (or how little can I get away with??) I'll start teaching in August and I want to keep as much of my salary as I can in order to buy a house in about a year.
I'm single and 25 years old in case that's relevant.
How much can I expect to pay per month for HMO (or how little can I get away with??) I'll start teaching in August and I want to keep as much of my salary as I can in order to buy a house in about a year.
I'm single and 25 years old in case that's relevant.
Posted on 7/1/14 at 9:02 am to bayoubengals88
Bayou, on the OGB website is the premiums that state employees pay.
Are you teaching in a local school district? If so, the employee share is a bit different, as I think each district decides how much to contribute, but it should give you a rough idea.
Are you teaching in a local school district? If so, the employee share is a bit different, as I think each district decides how much to contribute, but it should give you a rough idea.
Posted on 7/1/14 at 11:27 am to LSUFanHouston
Thanks. I'm assuming HMO is preferred? ...totally new to all of this!
Posted on 7/1/14 at 1:54 pm to bayoubengals88
I find the premium is cheaper, and the out of pocket costs are less, with the state HMO.
That having been said, you are limited with your doctor/provider choices in an HMO. The state network is pretty solid in New Orleans, so it's not an issue for us. But you might want to make sure you have good providers in the plan in your area, especially if you have a major medical issue.
That having been said, you are limited with your doctor/provider choices in an HMO. The state network is pretty solid in New Orleans, so it's not an issue for us. But you might want to make sure you have good providers in the plan in your area, especially if you have a major medical issue.
Posted on 7/2/14 at 1:25 pm to LSUFanHouston
I went HMO
Posted on 7/2/14 at 2:47 pm to Hu_Flung_Pu
Thanks everyone. I'm honestly looking to go the cheapest route possible since I'm young and single so I can max out my Roth (for now) on a teacher's income.
Is this unwise since 8% of my check will go toward retirement?
Is this unwise since 8% of my check will go toward retirement?
Posted on 7/2/14 at 2:58 pm to Croacka
I've been in the HMO for years; I haven't seen a single real advantage to PPO, but I admit that I haven't really looked at it that carefully for several years.
Posted on 7/2/14 at 3:29 pm to bayoubengals88
quote:
Is this unwise since 8% of my check will go toward retirement?
That's real cute, you thinking that retirement system is still going to be around in 30 years.
Yes, do the Roth if you can.
Posted on 7/2/14 at 3:49 pm to LSUFanHouston
quote:
That's real cute
I have my doubts, but damn! haha
Posted on 7/3/14 at 10:37 am to Croacka
Neither....CDHP with HSA
health savings account...triple savings....tax free contribs....tax free growth....tax free withdrawals for medical expenses.... have option to use as pre-tax IRA at age 65 on anything if choose.
health savings account...triple savings....tax free contribs....tax free growth....tax free withdrawals for medical expenses.... have option to use as pre-tax IRA at age 65 on anything if choose.
This post was edited on 7/3/14 at 10:43 am
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