Managed Care health plans are types
of health plans that are quite opposite to Indemnity Health plans or Open
Choice health plans. In case of Managed Care Health plans, individuals do not have complete freedom in choosing their
physicians but must select from a list of in-network/participating
providers. Managed Care plans mean controlled
access to doctors, clinics, hospitals, procedures, and medicines. These plans
can called Defined Benefit Health programs.
In spite of so many limitations, Managed
Care Health plans are very popular. In general, managed care plans are better
suited for the average individuals because these types of health plans are more
cost effective in the long run. In fact, this is an age of Managed Care Health
plans in the world of health insurance plans. This is because maximum benefits
are available in Managed Care Health plans at minimum costs. Health Maintenance
Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of
Service (POS) plans are known as Managed Care Health plans.
Preferred
Provider Organization
Preferred Provider Organization (PPO)
plans are an affordable and popular option for family health insurance because
they are comprehensive and flexible. Subscribers will save money covering their
family when they use preferred network physicians but a PPO also provides them
with coverage on out-of-network doctors as well.
PPO health insurance allows
substantial discounts from providers who are within the network. Deductibles must
be paid before the insurance companies start giving benefits. That is, after annual
deductible amount are paid, insurance company will start cost sharing of
medical expenses of the subscribers. For example, if the medical cost is $100
and cost sharing rate is 80%/20%, the insurance company will give 80 dollars
and the subscriber will pay 20 dollars from his pocket.
PPO health insurance is usually the
least expensive of managed care health insurance because the patient picks up a
substantial portion of the “first dollars” coverage with a higher
deductible. The higher the deductible
is, the lower is the premium.
Health
Maintenance Organization
A Health Maintenance Organization
(HMO) is one of the more affordable individual health insurance alternatives.
HMOs usually have an extensive network of doctors, specialists, hospitals, and
clinics. HMO networks often encompass a wide and varying range of healthcare
professionals. Subscribers will have convenient access to all their healthcare
needs.
Each subscriber/member chooses a primary care physician (PCP) who
sees to the overall care of that member. Specialists and non-emergency hospital
admissions usually require a referral from a PCP.
Point
of Service
Point of Service (POS) plans are
essentially a mixture of the HMO and PPO. Like an HMO subscriber can pick a
primary care physician but as in a PPO, they can seek help from any medical professional
in or out-of-network and they will still be covered.
POS plans are still managed care
resulting in lowered medical costs in return for more limited choices. Point of
Service health insurance is sometimes called an open ended HMO or PPO. The
major difference though is policyholders are allowed to seek help outside the
POS network though there is more of an incentive to choose providers within the
network.
POS members choose a primary care
physician (PCP) as they would in other managed care health care plans. From
there the doctor becomes the insured’s “point of service” and will refer the
insured to other healthcare providers.
