High Deductible Health Insurance From Your Corporation - Does Anyone Have It?

[MrCheapo]

We live in CA and most of our health care plans are HMOs. But we do have one which is a no premium (even in retirement) but high deductible ($3000 per individual and $6000 per family) with out of pocket maximums of $6000/$12000 (individual/family).

Essentially with this plan you pay everything upto the deductible and then co-insurance payments of 20% of the cost upto the out of pocket maximiums and then the plan covers 100%. I'm thinking of using it as: a) it's free and b) most importantly its a PPO plan so can be used anywhere in the world.

So I have several questions:

a) No doubt I'll be paying thousands of dollars per year out of pocket (but remember the cost is $0). Because I'll be retired I can use a health savings plan. Is there any way to pre-pay for this with tax-free dollars? My AGI in retirement will be $140K so it's not worth doing an itemized deduction.

b) Does anyone have these plans? It seems to be equivalent to our HMO services but I am unsure.

The plan details are here: https://ucnet.universityofcalifornia.ed ... verage.pdf

[Raspberry-503]

Wow, if it's truly free it's a pretty good deal, my deductibles are the same and I pay over $600/month. When I last looked that plans offered by my company, the max expenses all seemed to converge to the same amount. So if you got hit by a car or got cancer, I didn't matter which plan. If you never get sick, you save money with the high deductible plan (in your case t's no money at all). But just a few medical issues can cost you thousands unreimbursed.

To me the crown jewel of HDHPs is the ability to contribute to a Health Savings Account, many of which can be used to invest tax free, but you're in California and I thinks they are treated differently there.

[MrCheapo]

Thanks. Yes, it makes no sense to me. In retirement I can go on our current HMO plan currently cost $400 a month, zero deductible but in retirement is $1100 a month! So that plan's annual premium would be inexcess of the total out of pocket expense of the PPO plan.

So I must be missing something. Who would pay for the HMO plan where you are GUARANTEED to pay $13200 a year versus the PPO plan where you pay at MOST $12000?

Wow, if it's truly free it's a pretty good deal, my deductibles are the same and I pay over $600/month. When I last looked that plans offered by my company, the max expenses all seemed to converge to the same amount. So if you got hit by a car or got cancer, I didn't matter which plan. If you never get sick, you save money with the high deductible plan (in your case t's no money at all). But just a few medical issues can cost you thousands unreimbursed.

To me the crown jewel of HDHPs is the ability to contribute to a Health Savings Account, many of which can be used to invest tax free, but you're in California and I thinks they are treated differently there.

[Kenkat]

I have generally thought that every company offers a high deductible plan, sometimes with company contribution to an HSA.

My experience is that one way or another, you are going to pay. Either in higher premiums or higher out of pocket expenses. At least with the high deductible plans, if you don’t need a lot of medical care in a given year, you typically come out ahead.

If you can get a high deductible plan at zero premium, that’s a great value. I am paying around $1200/mo. for my wife and I to stay on my former employer’s plan as a retiree.

[MrCheapo]

I have generally thought that every company offers a high deductible plan, sometimes with company contribution to an HSA.

My experience is that one way or another, you are going to pay. Either in higher premiums or higher out of pocket expenses. At least with the high deductible plans, if you don’t need a lot of medical care in a given year, you typically come out ahead.

If you can get a high deductible plan at zero premium, that’s a great value. I am paying around $1200/mo. for my wife and I to stay on my former employer’s plan as a retiree.

Thanks. I wonder how one compares these plans to see if they cover the same things (or not). I'd hate to find out after taking out the plan, we aren't covered.

[backpacker61]

Thanks. I wonder how one compares these plans to see if they cover the same things (or not). I'd hate to find out after taking out the plan, we aren't covered.

I would check the health care providers you use to see if they are "in network" for the PPO.
Than can result in significant savings versus if they are "out-of-network".

[quantAndHold]

I have generally thought that every company offers a high deductible plan, sometimes with company contribution to an HSA.

My experience is that one way or another, you are going to pay. Either in higher premiums or higher out of pocket expenses. At least with the high deductible plans, if you don’t need a lot of medical care in a given year, you typically come out ahead.

If you can get a high deductible plan at zero premium, that’s a great value. I am paying around $1200/mo. for my wife and I to stay on my former employer’s plan as a retiree.

Thanks. I wonder how one compares these plans to see if they cover the same things (or not). I'd hate to find out after taking out the plan, we aren't covered.

If they’re all ACA compliant plans, they will all cover pretty much the same stuff. Like the previous poster said, I would check the provider network. In theory, a PPO is better than an HMO, but in practice, you want to stay within your network, because you will pay a lot more to go out of network. Most PPOs have significantly higher deductibles, out of pocket maxes, and copays for out of network than in-network.

[MrCheapo]

I have generally thought that every company offers a high deductible plan, sometimes with company contribution to an HSA.

My experience is that one way or another, you are going to pay. Either in higher premiums or higher out of pocket expenses. At least with the high deductible plans, if you don’t need a lot of medical care in a given year, you typically come out ahead.

If you can get a high deductible plan at zero premium, that’s a great value. I am paying around $1200/mo. for my wife and I to stay on my former employer’s plan as a retiree.

Thanks. I wonder how one compares these plans to see if they cover the same things (or not). I'd hate to find out after taking out the plan, we aren't covered.

If they’re all ACA compliant plans, they will all cover pretty much the same stuff. Like the previous poster said, I would check the provider network. In theory, a PPO is better than an HMO, but in practice, you want to stay within your network, because you will pay a lot more to go out of network. Most PPOs have significantly higher deductibles, out of pocket maxes, and copays for out of network than in-network.

Ah these are corporate health plans (until you are 65). How does one check if they are ACA compliant.

[quantAndHold]

I have generally thought that every company offers a high deductible plan, sometimes with company contribution to an HSA.

My experience is that one way or another, you are going to pay. Either in higher premiums or higher out of pocket expenses. At least with the high deductible plans, if you don’t need a lot of medical care in a given year, you typically come out ahead.

If you can get a high deductible plan at zero premium, that’s a great value. I am paying around $1200/mo. for my wife and I to stay on my former employer’s plan as a retiree.

Thanks. I wonder how one compares these plans to see if they cover the same things (or not). I'd hate to find out after taking out the plan, we aren't covered.

If they’re all ACA compliant plans, they will all cover pretty much the same stuff. Like the previous poster said, I would check the provider network. In theory, a PPO is better than an HMO, but in practice, you want to stay within your network, because you will pay a lot more to go out of network. Most PPOs have significantly higher deductibles, out of pocket maxes, and copays for out of network than in-network.

Ah these are corporate health plans (until you are 65). How does one check if they are ACA compliant.

I would assume they all are. HSA eligible plans all are.

[Kenkat]

I have found healthsherpa.com very useful for comparing ACA plans.

My employer retiree coverage is a PPO; the network is United Healthcare Choice Plus. I’ve never run across a non-network provider issue. It also covers a name-brand drug I need for $100 every 3 months vs. $1600 retail.

If I wanted to come even close to that plan with an ACA plan, I am looking at a Gold-tier plan. Even with those the networks are typically more limited and you have to really read the fine print to be sure prescription drugs are covered at a reasonable cost.

All of that combined with the fact that the ACA subsidies and other stuff are variable in the future, it was safer to go with the known quantity in spite of it costing more.

[MrCheapo]

I have found healthsherpa.com very useful for comparing ACA plans.

My employer retiree coverage is a PPO; the network is United Healthcare Choice Plus. I’ve never run across a non-network provider issue. It also covers a name-brand drug I need for $100 every 3 months vs. $1600 retail.

If I wanted to come even close to that plan with an ACA plan, I am looking at a Gold-tier plan. Even with those the networks are typically more limited and you have to really read the fine print to be sure prescription drugs are covered at a reasonable cost.

All of that combined with the fact that the ACA subsidies and other stuff are variable in the future, it was safer to go with the known quantity in spite of it costing more.

Thanks does your corporate plan shows up in healthsherpa.com? My corporate plan is administered by Anthem Blue Cross Life and Health Insurance Company so it should be reputable, but I'm struggling to understand how different (if at all) it is to the other plans.

Thanks.

[Kenkat]

I have found healthsherpa.com very useful for comparing ACA plans.

My employer retiree coverage is a PPO; the network is United Healthcare Choice Plus. I’ve never run across a non-network provider issue. It also covers a name-brand drug I need for $100 every 3 months vs. $1600 retail.

If I wanted to come even close to that plan with an ACA plan, I am looking at a Gold-tier plan. Even with those the networks are typically more limited and you have to really read the fine print to be sure prescription drugs are covered at a reasonable cost.

All of that combined with the fact that the ACA subsidies and other stuff are variable in the future, it was safer to go with the known quantity in spite of it costing more.

Thanks does your corporate plan shows up in healthsherpa.com? My corporate plan is administered by Anthem Blue Cross Life and Health Insurance Company so it should be reputable, but I'm struggling to understand how different (if at all) it is to the other plans.

Thanks.

No, healthsherpa only is covering ACA plans. It is the same information that is available on healthcare.gov but they organize, present and filter it better, I assume using an available API from healthcare.gov.

[pizzy]

I have found healthsherpa.com very useful for comparing ACA plans.

My employer retiree coverage is a PPO; the network is United Healthcare Choice Plus. I’ve never run across a non-network provider issue. It also covers a name-brand drug I need for $100 every 3 months vs. $1600 retail.

If I wanted to come even close to that plan with an ACA plan, I am looking at a Gold-tier plan. Even with those the networks are typically more limited and you have to really read the fine print to be sure prescription drugs are covered at a reasonable cost.

All of that combined with the fact that the ACA subsidies and other stuff are variable in the future, it was safer to go with the known quantity in spite of it costing more.

Thanks does your corporate plan shows up in healthsherpa.com? My corporate plan is administered by Anthem Blue Cross Life and Health Insurance Company so it should be reputable, but I'm struggling to understand how different (if at all) it is to the other plans.

Thanks.

Why aren't you currently using the PPO? How long have the current options been available (i.e. when was the last major overhaul)?

You said the HMO goes up in cost when you retire? But the PPO stays the same?

[MrCheapo]

I have found healthsherpa.com very useful for comparing ACA plans.

My employer retiree coverage is a PPO; the network is United Healthcare Choice Plus. I’ve never run across a non-network provider issue. It also covers a name-brand drug I need for $100 every 3 months vs. $1600 retail.

If I wanted to come even close to that plan with an ACA plan, I am looking at a Gold-tier plan. Even with those the networks are typically more limited and you have to really read the fine print to be sure prescription drugs are covered at a reasonable cost.

All of that combined with the fact that the ACA subsidies and other stuff are variable in the future, it was safer to go with the known quantity in spite of it costing more.

Thanks does your corporate plan shows up in healthsherpa.com? My corporate plan is administered by Anthem Blue Cross Life and Health Insurance Company so it should be reputable, but I'm struggling to understand how different (if at all) it is to the other plans.

Thanks.

Why aren't you currently using the PPO? How long have the current options been available (i.e. when was the last major overhaul)?

You said the HMO goes up in cost when you retire? But the PPO stays the same?

The HMO is super cheap whilst working, but becomes expensive when retired.

[pizzy]

I have found healthsherpa.com very useful for comparing ACA plans.

My employer retiree coverage is a PPO; the network is United Healthcare Choice Plus. I’ve never run across a non-network provider issue. It also covers a name-brand drug I need for $100 every 3 months vs. $1600 retail.

If I wanted to come even close to that plan with an ACA plan, I am looking at a Gold-tier plan. Even with those the networks are typically more limited and you have to really read the fine print to be sure prescription drugs are covered at a reasonable cost.

All of that combined with the fact that the ACA subsidies and other stuff are variable in the future, it was safer to go with the known quantity in spite of it costing more.

Thanks does your corporate plan shows up in healthsherpa.com? My corporate plan is administered by Anthem Blue Cross Life and Health Insurance Company so it should be reputable, but I'm struggling to understand how different (if at all) it is to the other plans.

Thanks.

Why aren't you currently using the PPO? How long have the current options been available (i.e. when was the last major overhaul)?

You said the HMO goes up in cost when you retire? But the PPO stays the same?

The HMO is super cheap whilst working, but becomes expensive when retired.

Is the PPO free? Why would you want an HMO over a PPO?

[bottlecap]

An HDHP is almost always the best solution. If you don't have to pay premiums, I can't imagine finding a better deal.

JT

[MrCheapo]

An HDHP is almost always the best solution. If you don't have to pay premiums, I can't imagine finding a better deal.

JT

Not always. Whilst working my HMO plan for a family of 4 is $300 a month so is a no brainer. but when we retire it jumps to $1100 a month. The HD plan is always $0 with a 12k out of pocket max.

[Normchad]

An HDHP is almost always the best solution. If you don't have to pay premiums, I can't imagine finding a better deal.

JT

I happen to agree with you. I can think of “don’t hole” cases where it doesn’t apply, but for a lot of high income folks, this is the way to go.

The HSA is incredible. The only place that is funded with tax deferred money, grows tax free, and comes out tax free. It’s a better deal than my 401k. So for me, the HDHP is worth it just to get an HSA.

[eigenperson]

Is the PPO free? Why would you want an HMO over a PPO?

Presumably because it's Kaiser in California, which is, more or less, the one HMO people actually like.

[pizzy]

An HDHP is almost always the best solution. If you don't have to pay premiums, I can't imagine finding a better deal.

JT

Not always. Whilst working my HMO plan for a family of 4 is $300 a month so is a no brainer. but when we retire it jumps to $1100 a month. The HD plan is always $0 with a 12k out of pocket max.

What is HMO out of pocket max?

[beyou]

I have generally thought that every company offers a high deductible plan, sometimes with company contribution to an HSA.

My experience is that one way or another, you are going to pay. Either in higher premiums or higher out of pocket expenses. At least with the high deductible plans, if you don’t need a lot of medical care in a given year, you typically come out ahead.

If you can get a high deductible plan at zero premium, that’s a great value. I am paying around $1200/mo. for my wife and I to stay on my former employer’s plan as a retiree.

Thanks. I wonder how one compares these plans to see if they cover the same things (or not). I'd hate to find out after taking out the plan, we aren't covered.

If they’re all ACA compliant plans, they will all cover pretty much the same stuff. Like the previous poster said, I would check the provider network. In theory, a PPO is better than an HMO, but in practice, you want to stay within your network, because you will pay a lot more to go out of network. Most PPOs have significantly higher deductibles, out of pocket maxes, and copays for out of network than in-network.

ACA plans in my area (NY) have NO out of network coverage. So to me they are almost no better
than an HMO. Your location dictates what is available via ACA.

[beyou]

My former employer of many years offered both HD hsa plan and lower deductible non-hsa plans options. Out of a lifelong habit took the lower deductible. Then downloaded 3 years data from insurer site. Some analysis shower that it was not worth paying a higher premium to get lower deductible in all but 1 really bad year. So I switched. Worked out better having hsa and less premium. Been spending the hsa on things not covered by my main policy (eye glasses, dentist). Overall was not a major financial decision one way or the other, and in my case same “network” either way. The network is what matters most and made it easy to switch when I did. Not so easy with new insurer.

[grabiner]

a) No doubt I'll be paying thousands of dollars per year out of pocket (but remember the cost is $0). Because I'll be retired I can use a health savings plan. Is there any way to pre-pay for this with tax-free dollars? My AGI in retirement will be $140K so it's not worth doing an itemized deduction.

Yes. When you contribute on your own to an HSA, you deduct this as an "adjustment to income" on your tax form, so it is subtracted from your adjusted gross income.

Note that CA does not recognize HSAs, so you won't get a state tax deduction, and you will pay state tax on any income earned in the HSA. If Treasury bonds fit your investment needs, the HSA is the best place to hold them, since CA will not tax the income.

[BalancedJCB19]

I have a HDH plan with an HSA. If you can get through the first couple of years without a major health event, you are golden. I max out my HSA every year and if I do have a situation where I have to pay for something it comes right out of the HSA. If I don't use it, it stays with me and I can pay my Medicare Part B tax from with it when I retire. It's a win/win. I was paying $1,200 a month for the other plan, now I pay $250 a month

[DarkHelmetII]

For years hdhp + hsa has been pretty much the only "logical" choice given lower premiums, hsa contributions from employer, and hsa tax benefit for my own contributions.

In most cases even when we blow through the deductible we "win" with the HSA due to OOP max not being that much higher.

What I have found is that if you end up with moderate healthcare consumption, there is a certain "sweet spot" (or maybe anti sweet spot) where a traditional plan would have provided for less total cost. But I seldom end up right on that spot of the spectrum.

[quantAndHold]

I have generally thought that every company offers a high deductible plan, sometimes with company contribution to an HSA.

My experience is that one way or another, you are going to pay. Either in higher premiums or higher out of pocket expenses. At least with the high deductible plans, if you don’t need a lot of medical care in a given year, you typically come out ahead.

If you can get a high deductible plan at zero premium, that’s a great value. I am paying around $1200/mo. for my wife and I to stay on my former employer’s plan as a retiree.

Thanks. I wonder how one compares these plans to see if they cover the same things (or not). I'd hate to find out after taking out the plan, we aren't covered.

If they’re all ACA compliant plans, they will all cover pretty much the same stuff. Like the previous poster said, I would check the provider network. In theory, a PPO is better than an HMO, but in practice, you want to stay within your network, because you will pay a lot more to go out of network. Most PPOs have significantly higher deductibles, out of pocket maxes, and copays for out of network than in-network.

ACA plans in my area (NY) have NO out of network coverage. So to me they are almost no better
than an HMO. Your location dictates what is available via ACA.

I think you miss my point. In my area, there are ACA plans that are actual PPOs. But, the already high in-network deductibles and out of pocketed maxes are doubled for out of network, and the premiums are $1000/month more. For people with employer plans, out of network coverage will have like a 40% copay instead of 10-20%. If I wanted to have surgery at an out of network hospital, it might be useful. But most people with PPOs will still get all or almost all of their care in network, because it’s expensive not to.

I have a HMO ACA plan. I also have a rare and aggressive form of cancer. In the past year I've had $173k worth of cancer care. I’ve also had the typical amount of “regular” medical care, because surprisingly, that doesn’t stop just because you get cancer. All of it was in network except for $1000 worth of 2nd opinions and consults from the world class cancer center in my area that I private paid for, which just confirmed that I was getting excellent care from my HMO. There is an ACA plan that covers the world class cancer center, but it’s $1000 more per month, and I’m getting excellent care with shorter wait times from my HMO, for a lot less money. And if my cancer becomes advanced, my HMO will refer me to the world class cancer center (and pay for it) anyway.

[MrCheapo]

For years hdhp + hsa has been pretty much the only "logical" choice given lower premiums, hsa contributions from employer, and hsa tax benefit for my own contributions.

In most cases even when we blow through the deductible we "win" with the HSA due to OOP max not being that much higher.

What I have found is that if you end up with moderate healthcare consumption, there is a certain "sweet spot" (or maybe anti sweet spot) where a traditional plan would have provided for less total cost. But I seldom end up right on that spot of the spectrum.

But do the HDHP have the same coverage as say the HMO plans? I worry that you end up with some awful disease and then realize it's inferior coverage.

[quantAndHold]

For years hdhp + hsa has been pretty much the only "logical" choice given lower premiums, hsa contributions from employer, and hsa tax benefit for my own contributions.

In most cases even when we blow through the deductible we "win" with the HSA due to OOP max not being that much higher.

What I have found is that if you end up with moderate healthcare consumption, there is a certain "sweet spot" (or maybe anti sweet spot) where a traditional plan would have provided for less total cost. But I seldom end up right on that spot of the spectrum.

But do the HDHP have the same coverage as say the HMO plans? I worry that you end up with some awful disease and then realize it's inferior coverage.

Yes. Your employer health plans, from the same provider at least, will have the same networks and coverage. They just have different levels of deductibles, copays, and out of pocket maxes.

[beyou]

I have generally thought that every company offers a high deductible plan, sometimes with company contribution to an HSA.

My experience is that one way or another, you are going to pay. Either in higher premiums or higher out of pocket expenses. At least with the high deductible plans, if you don’t need a lot of medical care in a given year, you typically come out ahead.

If you can get a high deductible plan at zero premium, that’s a great value. I am paying around $1200/mo. for my wife and I to stay on my former employer’s plan as a retiree.

Thanks. I wonder how one compares these plans to see if they cover the same things (or not). I'd hate to find out after taking out the plan, we aren't covered.

If they’re all ACA compliant plans, they will all cover pretty much the same stuff. Like the previous poster said, I would check the provider network. In theory, a PPO is better than an HMO, but in practice, you want to stay within your network, because you will pay a lot more to go out of network. Most PPOs have significantly higher deductibles, out of pocket maxes, and copays for out of network than in-network.

ACA plans in my area (NY) have NO out of network coverage. So to me they are almost no better
than an HMO. Your location dictates what is available via ACA.

I think you miss my point. In my area, there are ACA plans that are actual PPOs. But, the already high in-network deductibles and out of pocketed maxes are doubled for out of network, and the premiums are $1000/month more. For people with employer plans, out of network coverage will have like a 40% copay instead of 10-20%. If I wanted to have surgery at an out of network hospital, it might be useful. But most people with PPOs will still get all or almost all of their care in network, because it’s expensive not to.

I have a HMO ACA plan. I also have a rare and aggressive form of cancer. In the past year I've had $173k worth of cancer care. I’ve also had the typical amount of “regular” medical care, because surprisingly, that doesn’t stop just because you get cancer. All of it was in network except for $1000 worth of 2nd opinions and consults from the world class cancer center in my area that I private paid for, which just confirmed that I was getting excellent care from my HMO. There is an ACA plan that covers the world class cancer center, but it’s $1000 more per month, and I’m getting excellent care with shorter wait times from my HMO, for a lot less money. And if my cancer becomes advanced, my HMO will refer me to the world class cancer center (and pay for it) anyway.

Glad to hear you don't need the world class cancer center so far !

Regarding the issue that out-of-network is more expensive, yes it is. But I like to have the option to go where I want.
The employer plan I am losing soon (due to retirement and end of COBRA coming) allowed for both medical and dental out of network benefits.
I ONLY go out of network for dentistry, exclusively (though not the same financial penalty as going out of network for medical).
The employer plan has a fantastic network for doctors so there has been no reason to use the out-of-network benefits recently.
But in the past I had a son away at college, in a rural area. The only hospital in the area was out-of-network. I had two choices, buy another policy for my son or have him live with out-of-network coverage. We elected out-of-network coverage. Yes it has higher co-insurance but also a separate out of pocket max. I had an upper limit on what it would cost me, no fixed cost to buy an extra policy for him, and he could get the best care in the area close to home. Some people traveled to far away services and some bought insurance from the college at another $2k/year cost. Would have cost me $2k/year had I had no out-of-network benefits as the college would have forced us to buy their insurance.

My wife also is a cancer patient. Fortunately the flagship cancer hospital in the area was in-network for us.
But had it been out-of-network we would have gone there anyway since we had out-of-network benefits that we could elect ourselves.
When I was considering retiring, I looked at ACA policies available at the time (maybe 3 years ago or so) and at that point in time the major cancer center was out of network for any exchange sold policy in our area and none of those policies had out-of-network benefits where we could elect to just pay the higher co-insurance if we so choose. Fortunately since then the ACA plans must have worked out a contract with this major hospital as now they do take most of the local exchange sold plans in-network.

I have an adult child who outgrew my family employer plan, went on an exchange plan, and had cases where he needed out-of-network coverage for specialized services not found in-network. It was IMPOSSIBLE to get through any type of appeal successfully. The insurer suggested in-network providers who were not at all providing the same service required, and refused to grant out of network benefits of even a penny.

Unfortunately out-of-network benefits seem to be less and less common today, something I will have to live without soon after my COBRA ends,
until I can get on original Medicare. We are joining a major insurer with a very large network and hoping that will suffice, because we have no other options until 65. Probably will be good enough, but I hate living knowing that the insurers and providers can drop each other anytime, like cable dropping my favorite channel !

[DarkHelmetII]

For years hdhp + hsa has been pretty much the only "logical" choice given lower premiums, hsa contributions from employer, and hsa tax benefit for my own contributions.

In most cases even when we blow through the deductible we "win" with the HSA due to OOP max not being that much higher.

What I have found is that if you end up with moderate healthcare consumption, there is a certain "sweet spot" (or maybe anti sweet spot) where a traditional plan would have provided for less total cost. But I seldom end up right on that spot of the spectrum.

But do the HDHP have the same coverage as say the HMO plans? I worry that you end up with some awful disease and then realize it's inferior coverage.

There is both a 1) financial and 2) network component to "coverage" of any health insurance plan. My reflection of experience above is comparing variants of #1 while holding #2 constant. The question at hand seems to be that of changing both variables at once, e.g. HSA / HDHP PPO vs. low or no deductible HMO. And hence is more complex than the type of trade-off analysis I have done with my employers' plans over the years as I have held #2 constant.

Assuming neither PPO nor HMO options are "Grandfathered", they must all contain certain "essential health benefits" (EHBs). But there is nothing to prevent either plan from offering something above and beyond the EHBs. To figure out what exactly one may cover vs. the other requires digging into the legal plan documents. Furthermore, comparing the number of certain specialists etc.. based on capability, experience, and geographic convenience is a daunting task; theoretically possible but not sure how a layperson would do it in any sort of comprehensive, objective fashion. Generally speaking, what I have found is that HMOs are more likely to throw up roadblocks going to certain specialists yet others absolutely swear by HMOs (in a good way) due to the seamlessness between primary care physician, lab, and specialists.

My point is that the financial side of the equation is relatively easy to solve in my opinion and experience, but only if the network is held constant. Once there is a question about comparing the relative "strength" of the networks, that is much more complicated to empirically evaluate.