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HMO's vs PPO's

If you live in Illinois you won't find any individual HMO plans anymore because they proved to be unpopular with the consumer in this state, more expensive than PPO's rather than less expensive as they are in other parts of the country, and the infrastructure was never developed in this state as it was in the Northwest, Minnesota, and in the Northeast to insure a profitable plan for the insurance company, and cost savings for the consumer.

PPO's provide greater access to providers on one side and since HMOs in Illinois raised, not lowered premiums as planned they ceased to be a valid option in this state. HMO's are restrictive, and they offer quite a bit less choice than PPO's. Going with a PPO provides you with an expanded assortment of care options and higher out-of-pocket expenses and co-insurance rate.

How Do I Decide?

The decision between HMO and PPO can be complicated because the distinctions between them have blurred in recent years. Some HMOs have loosened their restrictions to woo consumers and while some PPOs that have tightened restrictions to lower costs.

The PPO May Be Best for You If:

• You want to be able to choose any doctor and live in a state like Illinois
• You have a chronic condition, such as back pain or arthritis
• You would prefer to use alternative medicine services such as acupuncture or chiropractors.

• You'd be unable to afford the added costs
• Live in the Northest, Northwest, or Minnesota
• You'll mind the extra billing problems that PPO members encountered compared to those enrolled in an HMO's since you are dealing with a wider variety of provider choices rather than just one or two.

• Your employee deductible will be around: $276.00
• Your co-insurance rate will be around: 10% to 20% in-network, and 20% to 30% out-of- network
• Your co-pay will be in the area of: $10.00
• Your annual family plan premium will be around: $2,152.00

For most of us, the choice of doctors available through a particular health plan is the most important factor in determining our overall satisfaction. So before you decide to enroll in either a PPO or HMO, ask around, see the physicians-roster of the plan you're considering and be sure that it offers plenty of acceptable choices. Finally, call any doctors you're interested in and make sure that they're still members of the plan and open to taking on new patients.

• You would prefer fewer billing hassles
• If you live in the Northwest, northeat, and Minnesota where established HMO networks are still thriving.
• You will need to keep your out-of-pocket costs as low as possible
• You have a family that will need annual physicals, well-baby visits, and OB/GYN care.

• You would prefer to keep your healthcare options more open
• Live in a PPO prominent state such as Illinois
• You regularly make use of specialist care and the need to get approval before doing so will be difficult for you
• You have a chronic medical condition and longer waits for needed care will be unfairly debilitating.

• You won't be responsible for a deductible or a co-insurance rate for in-network care
• Your co-payment will be around: $20.00
• Your family premium will be around $2840.00 annually

Before Selecting a Managed Care Plan

Do you have a chronic illness? If so, ask if the plan you're considering offers a disease-management program that will provide for intensive monitoring. Or, if you're a smoker or have experienced problems with your weight, you'll want to find out whether the plan offers a stop-smoking, weight-loss or any other alternative-medicine treatment program targeted to your needs.

Finally, don't stop scrutinizing just because you've made your selection. If you find something about your plan disappointing, report your problems immediately. Considering how much money you'll be shelling out, you have the right to demand the highest quality healthcare. If you have questions be sure to call us at 800-391-7469.

A few Important Factors Determine Your Satisfaction with Your HMO or PPO Plan:

1. How difficult is it for you to get the care that you and your doctor feel is necessary? Consumers in Illinois where turned off by the lack of choices.
2. Your choice of doctors.
3. How difficult is it to get in to see a doctor?
4. The quality of your plans customer service department.
5. How often do you encounter billing problems?
6. How satisfied are you with your primary-care physician's?