Which Plan Will Cost Me Less

Which Plan will cost me less?

Payroll deductions: The HMO has a higher payroll deduction as it is the more expensive plan. With the HMO you know you will pay more throughout the year as it is taken from your paycheck.

Annual Cost Difference between the HMO and the PPO:

Coverage Level / Annual HMO Cost / Annual PPO Cost / Difference
(HMO – PPO)
Employee Only / $152 / $0 / $152 (HMO costs more
Emplyee + Sp/Partner / $2,653 / $2,334 / $319 (HMO costs more)
Employee + Child/ren / $2,274 / $2,000 / $274 (HMO costs more)
Family / $4,624 / $4,168 / $456 (HMO costs more)

Another way to look at the above is that under the PPO your actual out of pocket costs would have to be higher than the HMO by the amount of the difference in payroll deductions before you are better off under the HMO.

Cost Sharing:

Doctors visits (PCP): Both the PPO and HMO have a $20 co-pay per PCP office visit

(Specialists): The PPO has a $20 co-pay per Specialist office visit; the HMO has a $25 co-pay per Specialist office visit

Routine tests: Under the HMO these are paid in full when ordered by your physician or subject to a 20% co-insurance if billed as a hospital service. Under the PPO these would be charged against your $500 deductible first. Once your deductible is satisfied they would be paid at 80% if done in-network.

Emergency Room: Under the HMO you pay $100 co-payment (waived if admitted) then covered at 100%. Under the PPO an emergency room visit would be subject to your $500 deductible first; when you have satisfied the deductible for the year it would be paid at 80%.

In-network Hospital Services: Hospital services under both plans are subject to the $500 deductible (Individual) and 20% co-insurance to a total out-of-pocket maximum of $1,500.

Out-of-networkHospital Services: Under the PPO out-of-network hospital services are subject to a $1,000 deductible and 40% co-insurance up to a $3,000 out-of-pocket maximum. You would be responsible for 100% of the cost of any out-of-network services under the HMO (the HMO provides coverage for only services performed within the Aetna network).

Prescription drugs: Prescription drugs work the same way under both plans.

Take a closer look at the Plan Summaries and side by side comparisons to review how other services are covered between the two plans. The Healthcare Reimbursement Account Estimate Worksheet can also assist you in estimating your total costs under either plan to compare against the difference in payroll deductions.