Video: HMO vs PPO Insurance for Prostate Cancer | Helpline Questions
Helpline Questions | Transcript
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 tofight your insurance company to get the treatment you want.