HMO vs PPO Insurance for Prostate Cancer

HMO vs PPO Insurance for Prostate Cancer


Hi, I’m Dr. Scholz. A common question we get
at the PCRI is, “Does insurance affect the quality of your medical care?” The answer is, it certainly can if you have
certain types of illnesses. When we talk about the different types of insurances we’re talking
about pre-paid or HMO insurance, private or PPO insurances, or Medicare which functions
in many ways like a private insurance. So, what’s the difference? Well, of course, the HMO insurances are really
insurance companies that employ physicians and they’re always trying to cut costs. I
find that HMO insurances are good, certainly, to save money. They’re pretty solid on the
common everyday illnesses like childbirth, or appendectomies, or high blood pressure,
and this sort of thing and they’ve been very popular because they are more economical.
Where HMO insurances tend to fall short is when people come down with a complex illness
like cancer. And I’m a prostate cancer specialist so I see the dichotomy of the way people with
HMO insurance are treated and the way people that have private insurance are treated and
there’s a big difference. The people who have private insurance have a lot more discretion
on choosing their doctors; the treatments are generally better funded; and there’s just
broader access to better care. So I mentioned that Medicare functions sort
of like private insurance, but many people do sign their Medicare over to become a sort
of an HMO insurance. They’ll get some additional benefits for drug coverage and whatnot, but
once again they will be restricted in the physicians that they can see and you’ll need
pre-approval for perhaps some of the more expensive treatments, whereas with general
Medicare your doctors and you will have a broader free discretion about what kind of
treatments you get. So, there’s a lot of choices out there and
in particular in prostate cancer because the majority of men are over age 65. This choice
between getting a prepaid Medicare type HMO versus holding on to regular Medicare could
make a difference in the quality of care that you can access with relative ease as opposed
to having to fight your insurance company to get the treatment you want.

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