I am in the process of choosing a health insurance plan at work. These two options are what I am considering: Anthem POS High Option - $42.00 Aetna HMO - Ohio(EPO) - $36.00 The HMO seems to have better benefits (100% coverage after $250 copayment vs 90$ coverage after $250 copayment for hospital coverage, 100% coinsurance percentage vs 90%, both have no annual deductible for in-network). The HMO option also has no annual out of pocket maximum while the POS high potion has a $1200 annual OOP maximum. Why is it that the HMO seems to have better options but costs less than the POS high option?
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With the HMO not only do you need a referal to see a specialist but you also need pre-approval from the insurance company before you receive almost any medical care. You must use a doctor or hospital in the network. If you travel outside of your area you may have a hard time finding someone. The annual out of pocket maximum is actually a good thing. That is the most you will spend during a year for your health care. If you look at the summary of benefits you'll see that even though the HMO is at 100% you still have co-pays to pay for every procedure. These co-pays can add up to well over $1200 if you have major health problems.
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