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How do you choose one HMO plan over
another – or one PPO over another? The
following discussion relating to HMOs, of course, also applies to
PPOs. The factors often
considered by beneficiaries are out-of-pocket costs and extra benefits.
These points, particularly details about prescription drug benefits,
should be considered. However, my focus is on the primary care
physician. I advise my clients
that they use the “doctor trail” to select the HMO –
first the doctor, then the doctor’s HMO. HMOs and PPOs are not the
diagnosticians – doctors are.
Often the individual doesn't have a doctor in mind, and
doesn't know how to go about choosing one. Over the past fourteen years
clients have often brought up this question. If the client is wearing
eyeglasses, I might suggest asking the eye doctor. Also, the choice may
have to factor in the specialist who has been playing an important role
in the client's health care. Another possible referral source is a
person whose judgment you respect, who works in a hospital and may have
heard the name Dr. John Smith over and over again as being a very good
diagnostician. Your primary care physician can play an important role
in your health care, so you must be diligent in your search. I would
first choose a primary care HMO-affiliated physician, who is still
accepting HMO patients. I would
then select that HMO, unless it has some serious drawbacks.
An example of using the "doctor trail" in
selecting an HMO: a new retiree
decides on his/her health care plan.
For the last several years that individual, up to the date of retirement,
has been well satisfied with the care of the physicians in the employer
HMO plan. That person then
simply inquires at the offices of those physicians about their
affiliations with Medicare HMOs – and joins the Medicare HMO with
which some, if not all, previously used physicians are affiliated
(after making certain he/she will be able to select from these
doctors).
Updated: July 20, 2005
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