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Comparing PPO Saver And HMO Saver |
Many understand that HMOs are ideal for simplifying decision-making and get valuable benefits for predictable costs while other health care plans offer low premiums and provide coverage for hospitalization and emergency services. Blue Cross of California offers both types of plans in the PPO Saver and the HMO saver plans.
The HMO Saver plan offers an annual deductible of $1,500 per member for inpatient, outpatient hospital services as well as ambulatory surgical center. The PPO Saver actually has separate deductibles including a $500 per person for emergency and inpatient or outpatient hospital services and a $5,000 deductible for all other covered services. Once two people have accumulated the deductible amount, the remainder of the enrolled family members’ deductible is considered satisfied.
Annual maximum out-of-pocket expenses are capped at $3,000 per member under the HMO Saver plan and when two members reach the maximum the maximum is satisfied for the entire family. With the PPO Saver, both medical deductibles apply towards the $5,000 per member annual out of pocket maximum amounts. Once two members have accumulated that amount, the maximum is satisfied for the rest of the family.
For visits to the doctor’s office HMO Saver members pay a $10 copay. Members of the PPO Saver plan pay a $30 copay for four visits per year for children and a $30 copay for adults for two visits each year. The deductible is waived for these charges. For professional services PPO Saver members pay 20 percent of the negotiated fee for inpatient or surgical fees only. Member must pay all other covered services until the maximum out-of-pocket expense is met, then the plan pays 100 percent. HOM Saver members pay nothing for related professional services.
Emergency room services will cost 20 percent of the negotiated fee once the $500 deductible is met for PPO Saver members while HMO Saver members will pay 20 percent of negotiated fees, subject to deductible. The PPO Saver plan offers no coverage for maternity while HMO members will pay $10 copay for office visits. After deductible they will pay 20 percent of the negotiated fee.
For HealthyCheck centers, PPO Saver members pay $25 for an annual basic screening and $75 for premium screening. Routine tests, such as mammogram, Pap and PSA, ordered by a physician, cost 20 percent of the negotiated fee. Well Child immunizations are 50 percent of the negotiated fee. HMO Saver members pay $10 office copay for health maintenance services.
Prescription drug coverage for Blue Cross Formulary drugs under the PPO Saver plan is $10 copay for generic drugs and $30 copay for name brand drugs after satisfying a $500 name brand deductible, with two members only needed to reach the maximum. Under the HMO Saver plan, the generic deductible is $10 with a $30 brand name deductible after a $250 name brand deductible is met. Under both plans, self-administered injectable drugs are charged at 30 percent of the negotiated fee, except for insulin.
Learn more at: www.baahealth.com
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