Managed Care

If choosing the most suitable Health Insurance plan your major goal is to minimize costs, a Managed Care plan may be the best option for you. The basic Managed Care principle is providing lower medical costs in exchange for more limited choice. There are three types of Managed Care plans: Health Maintenance Organizations (HM0s), Preferred Provider Organizations (PPOs) and Point-of-Service (POS) plans. The major differences of Managed Care from Fee-for-Service plans lie within two facts: the number of doctors and hospitals who participate in managed plans is limited, and you have to either find out which plans include your specialists or learn which plans your specialists have already joined. The other aspect of no little significance is that in order to keep costs low, your chosen doctor is encouraged to supervise the types of services you get and might need to approve of a hospital or a specialist you have to see, thus depriving such plans of flexibility indemnity plans offer.



Health Maintenance Organizations (HMOs) plan has an advantage of low premiums. With HMOs plan, you select a primary care physician to service your health needs and refer you to other in-network providers when required. This health care plan pays benefits only when you apply to doctors and hospitals in the HMO network. Coverage for out-of-network services is usually provided only for emergencies. Preferred Provider Organization (PPO) is a combination of HMO plans and Fee-for-Service plans. Like in HMOs, PPO medical treatment is fully covered if provided by a doctor or hospital referring to the PPOs network. Insured individuals receive basic medical care and pay fixed premiums on a monthly basis.

Using PPO plan, you are not obliged to choose a primary care physician and do not require referrals in order to see other specialists. However, if you want to apply for medical treatment outside the plan’s network, you will be paying more than people using health providers from within the PPO plan. Thus, with PPO plan, you will be able to choose between freedom of choice paying more medical bills yourself and an opportunity to recieve medical services at a lower cost from the network physicians.

Point-of-Service (POS) Plan:

If you decide to enroll in a POS plan, you will have to choose a primary care physician (PCP) from within the health care network who will supervise your health care. The primary care physician of your choice can make referrals to other providers in the plan and outside the network. If your physician makes a referral out of the network, the plan pays all or most of the bill. Members of POS plan can also refer themselves outside the plan. However, in this case your Health Insurance company will offer you only some portion of coverage. If you refer yourself to a health care provider outside the network and the medical services are covered by the plan, you will have to pay coinsurance.

With POS, you have more freedom and are not limited to HMO network providers only. Network care co-payments are quite low and there is no deductible. Paperwork for medical visits within the health care network is normally completed for you. However, there is a deductible for non-network care, and non-network co-payments are rather high. Employing doctors and services outside the network, you have to fill out the forms yourself, as well as send bills for payment, and keep an account of health care receipts.