At what point does an HMO become more expensive than a PPO? My employer’s PPO plan charges co-pays for doctor’s visits and prescription drugs. They charge a percentage of contracted expenses for other medical services, up to a yearly maximum – after which they cover 100%. The HMO charges co-pays for doctor’s visits, drugs, and hospital stays. It doesn’t charge anything for other medical services, but the devil is in the “pre-authorization”.

The catch is that recently the PPO co-pays have been cheaper than the HMO co-pays. The lesson here is that you can see a doctor and get drugged up on the cheap with the PPO, so long as you stay away from the other services. Who would have thunk it? On the other hand, the HMO doesn’t really want to pay for the other services either, so what you don’t pay in money you pay in sweat equity. Can you say “I want to speak to your supervisor?” How about “letter of appeal?” Maybe “state board review?” If you can’t, you have no business being in an HMO.

When is open enrollment again?

Does it make you angry that you could have been reading something else all this time?