What are Managed Health Care Plans?

By: George Wood

Most of the health services and financial issues related to healthcare insurance policies are handled by what is called managed health care. This is one of the most common ways of providing healthcare coverage to people across the United States. Managed health care strives to provide the highest quality healthcare to its members, along with other additional benefits.

Managed health care ensures that the patients are provided with healthcare in a most appropriate location, close to their home or even inside their home if a patient is that much ill and needs constant care. In addition to this, they also see to it that an appropriate provider is chosen to cater to the needs of the patient. These plans are composed of networks consisting of only a limited number of doctors and healthcare professionals unlike other health insurance services.

Mainly there are three types of managed care plans available to customers: Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and Point-of-Service (POS) plans. The features and benefits offered by each of these plans differ from one another. Also, there is a level of restriction found in each one of these plans. Before choosing a managed care plan you need to carefully assess your situation.

An HMO has contracts with medical professionals and hospitals that offer discounts to their patients. The patients or members are required to pay a monthly fee, regardless of whether they see a doctor every month or not. They also have to choose their Primary Care Physician (PCP) and always see him first before going to other members of the provider network. PCP is also known as a gatekeeper. So if you come across this term on a membership form, do not be surprised or worried. The patients will only be able to see specialists, for example a cardiologist, if this is first authorized by the PCP. Without a referral HMO is not responsible for the charges that specialist will ask for. If you have signed up with an HMO, you will have to select a doctor listed on their providers list. If you prefer someone else (for example a family doctor) you will have to select another care plan.

PPO works almost in the same way an HMO does, except that the patient does not have a PCP. PPO forms a providers network just like HMO, but patients can also choose a doctor from outside that network. However, the network is formed to give extra financial incentives to its members. Keep in mind that PPO costs more than an HMO because of the flexibility in choosing your doctor and the fact that you do not need referrals to see a specialist.

A POS plan is somewhat a combination of both PPO and HMO. It is also called an open-ended HMO. The patients or members are given the freedom of choosing either a PPO service or an HMO service depending upon their situation and the kind of healthcare they require. Sometimes seeing a specialist without a referral is very urgent and important. In such a case the members can go with the PPO and pay a little extra fee. In other cases when only a general physician would be sufficient to provide the necessary prescription, the members can go with HMO. Patients are also given the freedom of choosing their PCP if they want to. These kinds of plans are becoming increasingly popular because of the lack of restrictions and flexibility they have to offer to their members.

It is again encouraged that before jumping to one of these managed care plans you should carefully analyze your situation and the urgency of healthcare insurance.

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