HMO vs PPO?

Hi everyone, a bit of background… my work is changing our insurance carriers (and plans) and I’m having trouble deciding what plan to go with.

I am pregnant so will be delivering a baby next year which is part of the reason I’m having difficulty deciding.

The carriers are UHC and Cigna. The plans are identical in cost and coverage. Here are the plan details:

HMO: In-network coverage only Deductible: individual $150 / family $300 Cost of birth: $200 copay (after deductible) OOP max: individual $2,000 / family $4,000 Everything is covered via copays (imaging, specialists, etc.) Insurnance covers 100% of the bill after the copay so we wouldn’t owe co-inurance

PPO: In-network and out-of-network coverage Deductible: individual $600 / family $1,200 Cost of birth: 20% co-insurance (in-network) OOP max (in-network): $2,000 individual / $4,000 family OOP max (out of network): $4,000 individual / $8,000 family Most in-network services are 20% coinsurance, OON is 40%

The PPO is about $40 more per month for the premium.

My OBGYN is in both UHC and Cigna’s network. Overall, it seems like the HMO will be significantly cheaper out of pocket. We currently have an HMO so are familiar with the referral process for specialists. However, our biggest concern is what happens if there is an emergency when the baby is born? What if she needs to be in the NICU for an extended amount of time and a doctor in the NICU is OON? At least the PPO has a safety net of an $8,000 OOP max but the HMO doesn’t. I’ve called both Cigna and UHC to confirm my anesthesia is handled under the no surprises act (which it is) but I can’t seem to get confirmation on the NICU scenario. I will be contacting them again today.

My questions are: Would you recommend the HMO or PPO? Does anyone have experience with Cigna and/or UHC and would you recommend one over another?

Thank you so much!

submitted by /u/LandMermaid17
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