Health Insurance

About Managed Care Plans

Managed health care plans offer health care coverage to people.

• Health Maintenance Organizations (HMO)
• Preferred Provider Organizations (PPO)
• Point-of-Service (POS) plans

Health Maintenance Organizations - Here the participant has to choose a Primary Care Provider (PCP), who is on the HMO list of medical care providers. Medical care providers in the HMO network have an agreement with the HMO to offer medical services at a reduced rate. A person on a HMO plan will have to make a monthly premium payment, plus a nominal co-payment every time they see a doctor. The PCP approval is a must to see a specialist in the network. If a participant were to go to their preferred doctor outside their network, they have to bear all the expenses of the medical treatment.

Preferred Provider Organizations (PPO) - This plan works similarly like HMO, except the participant does not have to go to a medical care provider on the PPO list or get their approval for seeking medical care from a specialist. The participant is free to go to a medical care provider not on the PPO network, but will have to make higher co-payments for such visits. The part paid by the PPO for out of network medical treatment cost is lower and the participant’s contribution is higher.

Point of Service (POS) - This plan offers the beneficial features of HMO and the PPO Plan. Though a participant has to choose a PCP within the POS network, they are also free to take medical treatment from the medical care provider they wish. However, with this freedom comes a deductible payment and considerably high co-payment. If the participant were to take medical care only from within the POS network, their co-payment will be significantly lower and the paper-work easier.

In the United States, most people are set to go in for managed care plans. However, they must seek treatment only from the list of medical providers who come under the plan. In this sense managed care plans can be restrictive in nature. However, Managed Care Plans make sure to give treatment to patient through a medical care facility that is close to their place of stay, and it has been seen that if a patient is too ill, it enables them to get help from professionals who will give treatment at home. The medical care provider under the network of managed care plans are limited in number, but are known to give quality care.

Health Insurance Center

Why health insurance is a must for everyone

The process involved in claiming the Health Insurance.

Taken up by individuals who could not opt for job oriented health insurance

Insurance coverage offered by an employer

Different Sources for getting health insurance

Cobra is an unique law which came into effect in 1985

Program by the United States Government dealing with health insurance for the poor.

Health insurance for elderly people or one with disabilities.

Policy owners can choose from a preferred network of doctors.

Some of the factors determining cost on health insurance

Involves selecting a Doctor belonging to the HMO network

Comprises of the discussed three categories.

Medical Care Provider charges a fee which is paid or reimbursed by the insurance provider.