March 14, 2011

What type of health insurance plan do you prefer?

Health Maintenance Organization (HMO) plans typically have a lower premium cost with copays for services. However, HMO's lack the freedom found in other plans.  They require the member to see in-network providers and to go through an in-network primary care physician before seeing a specialist.

Preferred Provider Organization (PPO) plans don't require the member to see primary care physician before seeing a specialist. Plus, unlike the HMO, members can also see a provider who is out of the insurer’s network but pay more to do so.  PPO plans vary in deductible and copayment options. 

Health Savings Accounts (HSA) are coupled with high deductible PPO health plans. Pre-tax earnings deposited in the HSA can accumulate and grow year after year if not used. To preserve the tax benefits of these accounts, the money in an HSA can only be used to pay for qualified medical expenses (as defined by the IRS).

Comments

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John S.

John S. commented on March 14, 2011

Community Member

I prefer the HSA because it encourages me to be frugal with my health care dollars and rewards me for saving when and where I can.

Marie N.

Marie N. commented on March 14, 2011

Community Member

HMO's are usually one stop shopping and they take the guesswork out of which doctors you are allowed to see. I especially like the HMO's that are all in one building - if the dr. is in the building you are "in-network".

cantafforddrvisits

cantafforddrvisits commented on March 15, 2011

Community Member

I HATE that my company switched from a PPO plan to a CDHP plan. I pay, per paycheck, for my family's health insurance plan then have to pay FULL price for doctors' visits and prescriptions!! Yes, I know well-visits are covered 100%. That's the ONLY good thing about this. Thank goodness my company contributes to my HSA because that's the ONLY way I can afford this plan.

It's ridiculous. Make us more conscious about what we spend on health care? This is a load of poo. How about allow me not to be scared to take my 3yr old to the doctor when I think he may have strep throat because I know a $230 bill will be waiting for me in the mail a few weeks after his visit.

But, I'm stuck. It's the only plan my employer provides and my husband is self-employed... So, BCBS, you still have me.

gregparkr

gregparkr commented on March 15, 2011

Community Member

We have both a PPO and HSA option at work...I prefer the HSA option because I know what my maximum out of pocket expense will be for the year.

Angela B.

Angela B. commented on March 18, 2011

Community Member

I prefer a PPO because I typically only use my benefits in an office setting. It is nice knowing what my liability will be every time. It is dependable and I get a great network of doctors that I can go to. I don't need a referrels like in a traditional or HMO plan. The PPO plan just really fits my lifestyle.

winterfaeri

winterfaeri commented on March 18, 2011

Community Member

At the moment, the company I work for has a PPO. The deductible is HIGH and the co-pays are also high, but its better than nothing. Recently, our company failed to pay BCBSNC on time and our insurance was cancelled. However, we were not notified until nearly a month and half later. All bills incurred during that time became our personal responsibility. Horrible for some and not good for all. The insurance company should have to notify the insured BEFORE cutting benefits or they should have to cover any bills submitted for the time period when the "insured" unknowingly incurred healthcare costs... With computers and instant communication this should not be difficult.

NCNursePractitioner

NCNursePractitioner commented on March 18, 2011

Community Member

As a Nurse Practitioner, I prefer a HMO personally. However, at this point, I would take any type of health insurance for myself because I lapsed in my health insurance for 2 months while I was in graduate school. I had to make a decision between health insurance or food and gas. Now, as an employed individual who's only option is BCBS, I was sent a rejection letter yesterday that I have pre-existing conditions and BCBS will re-evaluate me on 3/31/2012... yes, a year from now. The pre-existing conditions are hypertension and diabetes, all from gaining weight and not being healthy while I was in graduate school. Now, the weight is coming off, the blood pressure and the blood sugar are going down, but BCBS does not know that. They just look at the age and the diagnoses and see that it could make them pay more than what they want to because in the end, it's all about money, not the patient. So this Nurse Practitioner will be seeing patients who have BCBS but I will not have any health insurance. Makes sense!

rufusd

rufusd commented on March 22, 2011

Community Member

Florida has a health information website maintained by the state of Florida that is very good. http://www.floridahealthfinder.gov/index.html I think it is a great site for consumers and those responsible for paying for healthcare, and provides lots of comparison and pricing information for prescription medicines, hospital facilities, various procedures, and providers. It would be great if North Carolina had similar reporting requirements and a website like this to help control our medical costs for both consumers and state medical programs. I am sure you will be interested in the prescription drug pricing part of the site here: http://www.myfloridarx.com/ Another part of the site is where you can look up the information on various hospitals around the state of Florida for specific procedures and pricing. I found this extremely useful to compare procedure prices against the estimates I got locally by phone from Wake Med, Rex, and Duke. If we had this type of database, we could easily find out which hospitals and providers are the most cost effective for particular procedures and treatments in North Carolina too. http://www.floridahealthfinder.gov/CompareCare/SelectChoice.aspx

Bethany H.

Bethany H. commented on March 23, 2011

Community Member

For many people, an HSA just doesn't work. I'm one of them. My employer has tried to convince me of the benefits (you know your OOP max, tax savings etc.) but when you take a prescrption medication that costs 1/2 your monthly salary, and the deductible is so high, there's no way I could ever use that type of plan. An employer contribution that only covers 1/4 of the deductible is gone in the first month, and how can I build up funds for expenses when I won't even be able to pay my mortgage or send my child to day care? If the company goes HSA only (and I fully expect it will), I don't know how I could possibly manage. If you are chronically ill, 100% preventive care doesn't help at all. I'd love to be frugal, but when there's only a very few drugs that treat my illness and I would be incapacitated without treatment I have no savings options.

Kymberli3

Kymberli3 commented on March 30, 2011

Community Member

I LOVE MY HSA! However, I don't think I would feel the same way if I didn't have my employer contributions! I use my HSA dollars for a lot of things that I couldn't really afford before. Since I don't go to the Dr a lot, I can use that money to pay for dental work for my kids or buy glasses and contacts without having to pay out of my pocket and then wait for the reimbursment.

dreaming_of_solutions

dreaming_of_solutions commented on April 3, 2011

Community Member

Okay the health insurance plan I like is the one I had when I was 21...and this was when I started with BC/BS...reasonable premiums, great benefits...simple no fuss insurance.

We don't need telephone aps, or for BC/BS of NC to support political bodies such as the Wake Education partnership. When you are trying to afford your health insurance policy with BC/BS it is frustrating is to learn how much money the leaders of BC/BS make...it hurts because some of that salary is from my hard earned money.

So here I sit worried that something bad will happen health wise to someone in my family--my monthly payment is so high I can't set any aside money for meeting our deductible or emergencies. My updated BC/BS policy requires that I pay for specialist visits...so breast cancer surgeon, neurologist for migraines...I have to pay full price...so what do I do? Skip the breast cancer check-up? Lower my work efficiency due to migraines???

Since 1981 I have been a BC/BS member and now that I hit middle age, I am unable to afford half the policy I had when I was in my twenties??? It is frustrating, unfair and evil.

Transitions

Transitions commented on April 8, 2011

Community Member

I like the HSA setup in theory, but it does not work. But I hate BCBS of NC. Your customer service when called on is worse than dealing with the IRS. I have been with BCBS for 12 years and I cannot wait till Medcost and United become more accepted in NC. BCBS has had a strong hold on NC for way to long they spend to much money promoting themselves (ie. sponsorships, meetings, travel) and not enough on the members that are supposed to take care of. BCBS is to top heavy, your in major need of a overhaul.

twonk

twonk commented on April 13, 2011

Community Member

http://www.business2community.com/health-wellness/no-insurance-necessary-medical-group-provides-quality-accessible-care-without-it-021482

I don't understand why this model isn't more popular. It's confusing to get four or five different bills for a single doctor visit, plus multiple mails from my insurer saying what is or isn't covered from each (one from the clinic/hospital, one from the doctors/nurses, one from the lab, another from specialists...). Is it realistic to use single point pricing (direct to doctor) for basic care, and then rely on insurance to cover the need for specialist visits, hospitalization, and critical care? Some municipal ambulance services offer this to citizens. Pay a low monthly membership fee (say $5/$10) and you don't have to pay $900 if you ever need an ambulance.

I want to write one check.

I want to be covered for everything or for nothing - not have to sort through seventy pages of jargon to determine whether I'm covered or not, or if I owe part or all due to coinsurance, copay, or deductibles, or one medicine over another medicine.

Nobody wants to need an MRI. Nobody wants to have to pay $2500 for it. But, no matter how much you exercise, or how many fresh vegetables you eat, you may not be able to avoid this need. That's why we have insurance: to cover us beyond our own means if we have sudden unexpected critical care requirements.

On the flip side, no one knows where to get a "cheap" MRI, or whether the report will be as thorough at lower cost in order to make informed decisions. So, there's little preventing health providers from overcharging.

I want to know what my costs will be up front, not have to guess.

daphne

daphne commented on April 13, 2011

Community Member

I completely agree that BCBSNC spends WAAAY too much time promoting themselves. For many people in NC they are the only option, so promotion efforts are for naught. And a mobile application that only helps you find a doctor isn't useful. I have doctors and I'm very familiar with where they are. Also, I'm really sick of hearing about saving money on healthcare costs. What they mean is BCBSNC will save money, not me. That really doesn't motivate me at all.

I prefer a PPO because I know exactly what my costs are and don't have to pay expensive costs out of pocket.

BlueAsksYouNC G.

BlueAsksYouNC G. commented on April 13, 2011

Community Member

I’m sorry to hear you have not been satisfied with the service you’ve received from BCBSNC. We would like to address the issues you are having. Please send a private message through the Submit a Question feature of this site (located on the contact link at the bottom of the homepage) with your service inquiry and we will do our best to resolve it as soon as possible.

Thanks,

The Blue Asks You NC Team

RDinNC

RDinNC commented on April 27, 2011

Community Member

Wellll... I am just happy to have health insurance that is not with BCBS-NC. After having BCBS-NC for 25 years under my mom's work plan, when I applied for an individual BCBS plan to hold me over until I got a full-time job after grad school, I was denied ONLY because I take an expensive medicine to help me digest food related to a genetic condition. I have no other lifestyle or health factors that would make me "ineligible". I expected to pay a higher premium, which would be fine because there is no way I could afford that medication w/o health insurance, and I will have to take it every day for the rest of my life. Health insurance should be not denied to those who need it. I was disappointed in BCBS-NC services and their claims to help people. After 25 years and an expressed need for health insurance, they did not hesitate to deny any option for continuing coverage for me. Thanks BCBS-NC.

RDinNC

RDinNC commented on April 27, 2011

Community Member

Amen! I had similar issues once I finished grad school w/o a full time job and was dropped from my Mom's BCBS plan. I needed insurance to help pay for expensive meds for a genetic condition, but I was denied (pretty much) because I have a real need insurance. What a mess!