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(POS) POINT-OF-SERVICE
(HMO) HEALTH MAINTENANCE ORGANIZATION
(PPO) PREFERRED PROVIDER ORGANIZATION
Your coverage with fee for service health care [back] Fee for service health care offers you unlimited choice. You control your choice of physician and facility, from primary caregiver to specialist, surgeon and hospital. Flexible coverage also means immediate treatment for medical emergencies or unexpected illness. But fee for service health plans do have care restrictions. Your costs with fee for service health care
[back]
As a rule, health care services not covered by your health Of course, not all fee for service health plans are created equal. There are various levels of coverage available. Basic, comprehensive, and major medical insurance [back] There are three kinds of indemnity insurance coverage:
Basic health insurance includes:
Major Medical insurance includes:
Comprehensive insurance is a combination of the two. The cost of your plan will vary with the level of coverage. Major medical insurance, for example, though popular, can carry a hefty price tag. Bottom line: fee for service health plans offer choice and security. But these advantages are reflected in the cost of indemnity insurance. Your other option? Managed care - which is up next. How these plans work (POS) [back] The POS is based on the basic managed care foundation: lower medical costs in exchange for more limited choice. But POS health insurance does differ from other managed care plans. When you enroll in a POS plan, you are required to choose a primary care physician to monitor your health care. This primary care physician must be chosen from within the health care network, and becomes your "point of service". The primary POS physician may then make referrals outside the network,
but then only some compensation will be offered by your health insurance
company. For medical visits within the health care network, paperwork is completed for you. If you choose to go outside the network, itis your responsibility to fill out the forms, send bills in for payment, and keep an accurate account of health care receipts. Advantages and disadvantages of POS health insurance [back] Think these through first. With a POS plan:
The cost [back] The breakdown of cost under a POS plan is similar to that of other managed care plans. It may be slightly less costly than a PPO because the health insurance company will still regulate most of your health care.
Your actual costs will consist of the monthly premium and a copayment
for health care services covered under the plan and within the POS
network. You'll also carry a deductible on any non-network care, and after the deductible is met, you'll still pay a higher percentage of the cost and maybe the difference between what the health care provider charges and what the plan deems to be"reasonable and customary" for the service. Questions to ask about POS health insurance [back] If you are wondering, which is better a PPO, a HMO, or a POS health insurance plan, use the list of questions below as a guide. If, for any reason, the POS policy does not answer to your satisfaction, be hesitant about purchasing it.
What is managed health care? [back] Managed care health insurance offers moderate health care coveragefor a relatively low price. But it's not all peaches and cream. The cost of being able to pay less for coverage is hidden in the restrictions to choose your own care. How it works. The basic principal behind managed care newtorks is controlling
costs by controlling care access. Managed health care plans differ
widely in their details, but all will seek to steer a patient toward
a pre-approved network of doctors and facilities, and limit coverage
of any treatment sought outside the network. Another difference lies in the type of care covered. Typically
managed care plans cover the cost of preventative care such as annual
check-ups and shots. Many medical treatments are also covered, but
often you must follow a strict procedure before receiving health
care from specialists or other physicians. There are different types if managed care plans (which we discuss further down) and they all have different levels of cost and choice. Your health insurance cost [back] If you follow the managed care plan requirements, most all of your
doctor visits, checkups, and shots, should be fully or partially
covered. However, managed care plans typically refuse to cover the
entire cost of health care services provided by a physician or specialist
not within Because of the restrictions, it is generally easier to predict
the annual cost of health care under managed care plans than with
an indemnity plan. Here's, generally, what you can expect to pay:
If you go to a doctor within the health care network you will
pay:
If you choose to go outside the health care network you will
pay:
Sidebar When you are ready to start comparing heath plans, includingthe
types of coverage you may You should also supplement your search by filling out a quote request form at Insurecom, a service that will put you in touch with agents right in your area who can help you design an insurance package to fit our needs. Three types of managed care plans [back] Managed care today is a lot different from its early days. Not least among the changes is the range of plans there are, with three main types: The three types are:
The basic characteristics of the first three are the same.
The differences between each managed care plan lie mainly in the
degree of compensation you will receive for medical treatment outside
the managed care network. It's a good idea to know the characteristics of each. We'll start
with the HMO, then look at PPOs and POS plans. We'll also examine
medical savings accounts, which are very similar to an IRA (yes!)
and have similar tax advantages, along with the medical coverage
optionsthey provide. How an HMO works [back] When you join an HMO, you pay a fixed monthly fee, called a premium.In
return, the health insurance company and its health care network
provide a variety of medical benefits. The range of health care services covered by an HMO varies, so
itis important to compare available plans. Some health care services,
such as outpatient mental health care, are often only covered on
a limited basis. Health maintenance organizations consist of a network of physicians.
From this list, you choose a primary care physician, who is thenresponsible
for your health care as well as for making referrals to specialists
and approving further medical treatment. Usually, your choice of doctors and hospitals is limited to those
on the list - since they have agreements with the HMO to provide
your health care. However, exceptions may be made in emergencies
or when medically necessary. Generally, the health care services offered will require you to
make a co-payment. A standard payment is five to ten dollars perdoctor
visit and five dollars for prescriptions. Some health insurance plans and some services charge nothing. The drawback of any HMO policy is that no care received outside of the health care network is covered. Advantages and disadvantages of HMO health insurance [back] Many people like HMO health insurance because they do not require
claim forms for office visits or hospital stays. Instead, HMO members
present a card, like a credit card, at the doctor's office or hospital.
However, in an HMO you may have to wait longer for an appointment
than you would with an indemnity insurance plan. Because the HMO health insurance company charges a fixed fee for
your healthcare, it is in their interest to make sure you get basic
health care for your medical problemsbefore they become serious. Although there may be a small copayment for each office visit,
your total health care costs will likely be lower and more predictable
in an HMO thanwith fee-for-service insurance. Unfortunately, there are drawbacks to these health insurance plans
too. It is difficult to get specialized care under an HMO plan since
you must firstobtain a network referral. Any health care cost from
other providers, except in emergencies, is not covered. The most
problematic, The cost of an HMO [back] Since an HMO exercises more control over your health care than other managed care plans, the cost is also more controlled. On top of the monthly health insurance premium, there are very few other fees when using network providers. For health care services covered under the plan, HMO plans require you to make minimal co-payments for services rendered. Non-network care, however, is rarely ever covered. Instead, you are responsible for paying the entire medical bill. Questions to Ask About an HMO [back] If you are struggling with how to evaluate the quality of your
HMO plan, or if you need to compare an HMO versus PPO, use the list
of questionsbelow as a guide. If, for any reason, the policy does
not answer any question to your satisfaction or the company's information
on health
Finding an HMO to suit your medical needs and budget [back] HMO premiums can vary considerably, even within the same state. How PPO insurance works [back] On a health insurance "scale", PPO insurance lies between HMOs andpure fee-for-service plans. Your health care is managed (and so restricted),but you are granted a degree of choice in providers. A PPO health insuranceplan operates like an HMO in that you pay a fixed monthly premium, and, in return, the health insurance company and its health care network provide basic medical benefits to you. However, a PPO does differ from the original HMO blueprint, primarily inthat under a PPO insurance plan, a primary care physician or "gatekeeper" physician is not required. As a result, seeing a specialist does not require a referral. If you need or want health care from outside the network, you should expect to pay a higher co-payment than if the provider were from within the PPO network. In essence, each time you need medical attention, you can decide betweenan higher costing indemnity plan with total freedom of choice over care ora lower costing HMO plan that restricts your care to within a network. Advantages and disadvantages of PPO insurance [back]
The cost of PPO insurance [back] PPO insurance is generally the most expensive type of managed care
plan. Even with a premium comparable to that of. say, an HMO, the
other fees associated with PPO insurance can increase its cost significantly. Just what are these costs? Well, on top of the premium, you can expect to pay coinsurance (lower charges if using network providers and higher chargesif using non-network providers). For preventative services, co-insurance is usually waived and, instead, but may be replaced with a (low) co-payment.
Don't necessarily let these extra fees scare you away from PPO
insurance.It is popular for a reason. It's simply important to note
that premiums alone are not an accurate indicator of your potential
yearly medical costs under a PPOinsurance plan. Sidebar If you want find out how much a PPO plan would cost you, get an instant health plan comparison quote at eHealthInsurance. Or, if you want personal attention from an agent in your area who will work with you to help you choose the best type of plan for you, visit Insurecom.
If you are struggling with how to evaluate the quality of your
PPO plan orwant to know how an HMO compared to a PPO does service
wise, use the list of questions below as a guide.If, for any reason,
the health insurance policy does not answer toyour satisfaction,
be hesitant about
What is Medicare? [back] Medicare is the federal government program that gives you healthcare
coverage if you are 65 or older, or have a disability, no matter
what your income. Medicare is divided into two parts: Part A and Part B. Medicare Part A covers inpatient hospital, skilled nursing facility,
home health and hospice care. Medicare Part B covers almost all reasonable and necessary medica
services,including doctors' services, laboratory and x-ray services,
durablemedical equipment (wheelchairs, hospital beds), ambulance
services, outpatient hospital care, home health care, blood and
medical supplies. Eligibility [back] You are eligible for Medicare if: What Medicare Covers - Under Medicare Part A [back] In 2004 You Will Pay Monthly Premium
Inpatient Hospital
Skilled Nursing Facility No deductible for each benefit
period Home Health Care No deductible or coinsurance Hospice Care No deductible Want to learn more about home health and hospice? What Medicare covers-Under Medicare Part B [back] In 2004 You Will Pay
Medicare does not cover the following services
Medicaid [back] Medicaid is a program that pays for medical assistance for certain individuals and families with low incomes and resources. This program became law in 1965 and is jointly funded by the Federal and State governments (including the District of Columbia and the Territories) to assist States in providing medical long-term care assistance to people who meet certain eligibility criteria.Medicaid is the largestsource of funding for medical and health-related services for people with limited income. What Is Medicaid? Medicaid is health insurance that helps many people who can't afford medical care pay for some or all of their medical bills. Good health is important to everyone. If you can't afford to pay for medical care right now, Medicaid can make it possiblefor you to get the care that you need so that you can get healthy - and stay healthy. Medicaid is available only to certain low-income individuals and
families who fit into an eligibility group that is recognized by
federal and state law. Medicaid does not pay money to you;instead,
it sends payments directly to your health care providers. Depending on your state's rules, you may also be asked to pay a small part of the cost (co-payment) for some medical services. |
