Health Insurance

What Types of Health Insurance Plans Are There?

In the United States, we hear the term Managed Care mentioned all the time but what is it? Insurance companies use Managed Care in order to help control cost.

If someone needs to go to the hospital, one form of managed care requires that a person get approval from their insurer before they are admitted.

It is up to the insurer to say whether you need to be hospitalized or not. If you go to the hospital without this approval, you may not be covered for the hospital bill.

Managed Care: An Explanation

Fee-for-Service Plans

This is the most use plan. Insurers pay a certain percentage for services provided to the people they insure. This type offers most patients more choices of doctors and hospitals. Under this plan, people can choose any doctor and change doctors when they want. They are also insured should they need to go to a hospital out of their town or state. People pay a monthly fee for this plan.

A deductible is usually required to be paid by you before the insurance pays their part and is usually starts over every year. The deductible might be $250 for every person that is on the plan. Only health expenses covered by the policy count toward the deductible. When a person has paid for deductible amount, they begin to share the bill with their insurer.

A coordination of benefit clause may put a limit under two plans to not exceed 100 percent of the claim.

Preventive health care coverage such as immunizations and well-child care may or may not be covered.

• Basic Protection pays toward the costs of a hospital room and care. It covers some services such as x-rays and prescriptions. Also pays toward surgeries.
• Major Medical makes up for what the basic coverage doesn’t pay. It covers the long, high cost care.
• Comprehensive plans combine major and basic polices into one. Make sure you have both kinds.

Health Maintenance Organizations

This is a prepaid health plans. In exchange for your monthly payment, HMO provides comprehensive care to include emergency care, x-rays, lab work, regular doctor visits and therapy. Your choices of which doctors and hospitals to use are limited to those in network. Exceptions can be made in cases of emergencies.

Co-payments are usually requested for each office visit in the amount of $5 to $15 and $25 for hospital emergency room visits.

HMO’s are more predictable than fee-for-service plans and will probably be lower in costs but they may have a longer wait then those using the fee-for-service plans. Members also present a card, like a credit card, at the doctor’s office or hospital instead of having to fill out claim forms.

Before you choose the HMO option, it is good to ask those already enrolled in the plan if they like the treatment they are given.

Point-of-Service Plans (POS)

This is a plan offered through HMOs and is an indemnity-type option. Primary care doctors in this plan frequently make referrals to providers in the plan. In this plan, members may be capable to refer themselves outside the POS plan and still get a little coverage. If doctors make a referral outside the network, the plan will pay all or most of that bill. If you refer yourself outside the network and the service is covered, chances are you will have to pay a coinsurance.

Preferred Provider Organizations (PPOs)

PPOs are a mix of HMOs and traditional fee-for-service. There are limited doctors and hospitals you can choose from. When you use these “network” providers, most medical bills are covered. Under this plan, you also present a card and no forms are required and co-pays are requested. Deductible’s and coinsurance’s are also a factor.

Most PPOs cover preventive care to include annual visits, well-baby care, immunizations, and mammograms. You may still use doctors who aren’t in the plan and still get some coverage. You may pay a bigger portion of the bill and also be stuck filling out the claims forms yourself.

Types of Health Insurance

• Individual & Family Health Insurance
• Business Health Insurance
• Dental Insurance
• Vision Insurance
• Disability Insurance