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Would you pay more to keep your doctor?

October 21, 2010

My job offers a variety of health insurance options for me to select from.  HMO A, HMO B, PPO, and a High Deductible Health plan + Health Savings Account with $700 (HDHP from now on).

Basic Health Insurance Background: HMOs require you to get referrals from your primary care physician to see specialists, and you can only use certain doctors.  HDHPs generally only cover a yearly exam, and do not cover my BC pills, but my company puts money in a Health Savings Account (this is different than a Health Spending Account) to help out.  The PPO is a traditional insurance with in-network and out-of-network doctors, but you can see whoever you want.

Currently, T and I are both covered by HMO A and pay no monthly premium for this coverage. Seeing the doctor requires a $10 co-pay and my prescription is $5/month (and could be less if I figured out how to do mail order).   I typically only go in for my yearly exam, and I really like my doctor and the location of the office.  T is also covered through his university (as part of his compensation package), so he hasn’t used my insurance at all.

Next year, my current plan  HMO A and the PPO will be about $35/person, while HMO B and the HDHP will have no month premium.  I like my doctor, but at first glance, I figured we’d just move over to HMO B, even though I’m a fan of my doctor.  It is the cheapest, and would provide me with any service I may need, and my loyalty to my doctor can be broken for $840/year (pre-tax, 70×12).

I glanced through HMO B‘s list of Primary Care Physicians accepting new patients and was… not happy.  First, there are no really ideal locations, just  2-3 “acceptable” locations.  At those locations, the only doctors accepting new patients are male.  I have had both male and female doctors, but strongly prefer females for a variety of reasons.  So…. hmmm….  They website cryptically said that not all physicians are listed in their online directory (why not?!) and I can call them to request a copy. But if there is not a convenient location with a female accepting new patients, this is not going to work for me.

I’ll have to run the numbers for signing us both up for the HDHP or signing me only up for HMO A and ceasing to double cover T. He hasn’t needed my insurance at all, but it is important that he has insurance that will cover things like… major bicycle crashes.  Other than that, he’s in good health.  We’ll have to see how good his current coverage is, but his last (minor) crash, he only used university services anyway.

An HDHP is cheap overall if you don’t have any major medical events, but my BC currently eats up most of the company contribution.  I would take this more seriously if they covered birth control, but  only “preventative” drugs are.  (I’m preventing a baby!)  Still, it might be worth the gamble. Again, it leaves us vulnerable if T has a major bicycle crash, but I suppose we’d get $1400 from my company to use through the year.  (This money is not use it or lose it like a Health Spending Account.)

How important is knowing and liking your doctor?  Is it worth $840/year?  How about $420/year?

6 Comments leave one →
  1. October 22, 2010 7:58 am

    My company only has 2 options: HMO or PPO. The HMO is $5/month and PPO is $20+/month. I lucked out and chose my primary care physician (PCP) at random just over two years ago when I started working, and it was based on location. I absolutely LOVE my female PCP, and I’ve seen a few of the male doctors there when I needed an immediate consultation and they have all been fantastic. My co-pay is $10/visit and I go maybe 2-3x a year. I really think you should like (and be comfortable with!) your doctor. 🙂

    • Sp permalink*
      October 22, 2010 9:04 am

      I lucked out too – I picked this HMO last year and somewhat randomly picked my doctor! But they switched the options on which HMO is free. Boo! I’m still deciding what to do about that, and find it surprising that the second HMO is as expensive as the PPO!

  2. October 22, 2010 11:33 am

    Wow…you guys are lucky. My company provides HMO and PPO (two different PPO Plans, three plans under each) but the HMO costs $80 per paycheck (so $160/month) and the PPO costs around $70 per paycheck for the medium plan ($140/month). Co-pays are $25/visit. Why the heck is it so expensive??

  3. karen permalink
    October 23, 2010 3:19 pm

    I’d probably stick with my doctor. I don’t think my dentist is in network but I really like the office (esp for a dentist lol) and it’s extremely convenient as they’re down the road from me.
    I’m still searching for a good PCP. Our insurance changed again due to Obama so I need refresh my memory and see if networks matter – sad as enrollment was just finished last week!

  4. Bonnie permalink
    October 25, 2010 10:09 am

    I pay extra for the PPO plan (about $30/month) so that I can keep all of my fave doctors (PCP, derm). Plus, I like my relatively low deductible.

  5. October 25, 2010 11:48 am

    health care in the states sounds sooo confusing! I would dread this decision!

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