Comparing Health Insurance Options - CDHP Vs. PPO Vs. EPO

Updated on November 07, 2012
J.B. asks from Boston, MA
5 answers

Ah the joys of open enrollment! My company actually administers heath plans for employers so you'd think our own comparison tools would do the job but I'm not getting the answers I need there.

What have your experiences been with consumer-directed health plans vs. preferred provider networks vs. an exclusive provider network (HMO/EPO)? If it helps, our choices are Aetna for the first two and UnitedHealthCare for the EPO.

I have been on UHC for many years but for a variety of reasons, we're now considering the other options.

The CDHP & PPO look similar - 80% in network coverage after deductible (60% out of network), no charge for physicals and other preventative care. EPO is $20 co-pay for PCP, $40 for specialist, $125 for hospital/ER. Prescription coverage same across all plans except for CDHP you have meet a deductible first.

So the costs - EPO is $7400 per year, plus co-pays. With a lot of counseling session for various family therapy issues, ADHD management, etc. those add up to probably $1500 per year. Husband has a lot of health issues but the rest of us are pretty healthy.

CDHP is $2900 per year, $2500 family deductible, out of pocket max $6K ($12K out of network).

PPO is $5400 per year, $1K in-network deductible ($2K out of network), $6250 out of pocket max ($12.5K out of network).

If you've made this switch, how much homework did you do? If we were to max out our out of pocket expenses (assuming everything is in-network) then the PPO would be the most expensive and the CDHP & EPO would be similar. But I have no idea how much things cost to therefore no idea of whether or not we'd max out realistically. If you've had various types of plans, are there advantages and drawbacks among them?

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So What Happened?

Thanks everyone - Christine, this has NOTHING to do with the affordable care act. I am insuring a family of 6 and have no qualms about how much I pay, which is a fraction of the cost of my policy (my employer picks up a substantial amount). The EPO is about a 10% hike over last year's price, but we've had those kinds of increases every year for years.

Time to figure out what the out of pocket costs for everything we use would be. Ugh.

More Answers

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C.S.

answers from Milwaukee on

Not sure if this will help, but we just went through open enrollment as well and our company offers three plans thru UHC.

Traditional & 2 higher deductible plans with HSA's. All of the options have a PPO attached to them, (with in/out network option).

We went with the highest deductible option which is $6,000, (with our company off setting it by chipping in $1,000.-so really it's 5k). Per check it is the least amount taken out: $66.58 over 26 checks. Then I'm taking the difference between the $66.58 and what the other HSA option costs per check, ($175.) and placing that into our HSA.

Our out of pocket max is 11K-this year we are going to average about 7K by year end.

That all is of course in network-out of network pricing will make your nose bleed. :)

My biggest concern is being able to go to the dr we need to go too and luckily the PPO provides that.

Hope that helps.

1 mom found this helpful
Smallavatar-fefd015f3e6a23a79637b7ec8e9ddaa6

C.S.

answers from Miami on

This is what Obamacare will bring? Not an answer for you but I'm going to go drink now.

1 mom found this helpful
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B.D.

answers from Pittsburgh on

Only you know how you use your insurance and which network serves you best. Personally I would assess how I use my insurance, which one will minimize my out of pocket costs, while giving me access to the doctors and hospitals I want to utilize.

Smallavatar-fefd015f3e6a23a79637b7ec8e9ddaa6

T.A.

answers from Seattle on

I work in medical billing and would always pick Aetna over united, united is the worst out there in my experience. Any plan that doesn't need referrals for everything would be fine.

Smallavatar-fefd015f3e6a23a79637b7ec8e9ddaa6

S.B.

answers from Redding on

You know your health needs for each member of your family.

Consult a broker who can help you make comparisons.
You need to keep in mind monthly premiums, maximum out-of-pocket expenses, preventative care, etc.

I've been in a position where it was best for me to pay more out of pocket in premiums because my out of pocket expenses for care were much lower and with my max out of pocket limits, the more expensive plan saved me money in the long run. I haven't been the healthiest person, and that's what worked really well for me.

It's different for everyone. Only you know the average that you spend on healthcare and premiums. Only you know what benefits you NEED from a specific plan. Get someone who is experienced in going over all this with you to help you make a decision.

In response to another poster, Health Care Reform, referred to by some as "Obamacare" hasn't been implemented yet. That wasn't even part of your question.

Get quotes, free of charge. Crunch the numbers and see what will work best for your family.

All situations are different. Concentrate on your needs and what will work best for you.

Best wishes.

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