Features of Private Payers and Consumer Driven Health Plans

The HMO’s stress wellness and preventive care, therefore its focus is more on health maintenance rather than just the treatment itself. Because of this, HMO’s offer much richer benefits than the traditional plans. HMO’s have little to no upfront costs in an effort to encourage maintenance, while comprehensive and major medical plans have up-front cost sharing so as to discourage over utilization.

The accounts can be used for eligible medical, dental, vision and prescription expenses incurred during the plan year. The funds generally do not roll over from year to year (though some employers do allow for a run-out period at the beginning of the next plan year). The accounts are commonly referred to as "Use-It-Or-Lose-It" accounts for this reason. One key differentiator between HSA and HCFSA is that the funds are available from the very beginning of the plan year rather than becoming available as they accrue. Employers fully fund the account up front and the participant pays this back over the course of the plan year via payroll deductions (Pub

The United States currently employs a multipayer system. The payers in this system include the government and private insurance companies., thus the collection of money for health care is a joint responsibility of both parties. Private insurance companies collect premiums and other payments from enrolled individuals and businesses. The government collects taxes from individuals and businesses. Regarding reimbursement, the private insurance industry reimburses providers for health care services delivered to privately insured individuals, while the government reimburses providers for health care services delivered to publicly insured individuals (e.g. people enrolled in Medicare, Medicaid, S-CHIP, or the VA).

"Compared to Medicare fee-for-service, managed care plans typically cover more services and impose lower out-of-pocket costs but is limited to the providers authorized by their plan" (Scanlon, 1998). The question of quality of care and services provided started to chink away at the armor of managed care.

A preferred provider organization (PPO) plan gives patients the flexibility to see providers and specialists within or outside the network of care; it will typically cost less to receive care from an in-network provider (U.S. Centers for Medicare & Medicaid Services, n.d.). In most cases, referrals for specialists and designating one physician as a primary care provider is not required of a PPO plan. (U.S. Centers for Medicare & Medicaid Services, n.d.). Alternatively, a health maintenance organization (HMO) limits patients to receive care from doctors, specialists, and hospitals covered under the health plan (U.S. Centers for Medicare & Medicaid Services, n.d.). With the exception of emergency can and out-of-area urgent care, all care providers

The changing landscape of the current health care system in the United States has caused new methods of insurance to gain in popularity. The High-deductible health plan (HDHP) is increasingly favored by employers and offered on the exchanges created under the Affordable Care Act (ACA). According to the Centers for Medicare & Medicaid Services (CMS) a HDHP is “a plan that features higher deductibles than traditional insurance plans. High deductible health plans (HDHPs) can be combined with a health savings account or a health reimbursement arrangement” (2015). In the HDHPs premiums are lower, offset by the higher deductible. The health reimbursement arrangement (HRA) the employer contributes to a fund for medical expenses while in the health savings account (HSA) which employees pay into but is not required of the employer (Shi & Singh, 2012, p. 208). The growing popularity of these plans is important as it will have effects on the healthcare costs as well as how consumers use healthcare.

We want to share a little bit of information is important to those of you are buying individual policies on the public exchanges. The plans on the exchanges, and in general, are typically far more affordable when you’re looking at the plans that have a higher deductible. The plans that have been considered most affordable and have really received the most attention from folks buying individual policies have been the HSA qualified plans.

managed care grew more in the last years, bringing about new types of managed care plans through competing MCOs. To make their plans more attractive, organizations used payment variations. For instance, instead of capitation, PPOs used discounted fees payment. There were ones that offered enrollees choices between affiliated providers and non-affiliated providers. MCOs also adopted various methods to control health care costs by actively monitoring utilization (Shi, Singh, 2017). Additionally, private health insurance, as well as high deductible health plans, can be offered as managed care plans nowadays. Also, available to Medicare and Medicaid recipients is the option to enroll in a managed care plan or continuing to stay with the traditional fee-for service program. Now for specific services HMOs incorporates capitation and fee-for-service reimbursement, in their payment schemes.

There are many ways to educate your staffs, is to give them the option to choose between the defined-contribution plans, direct contracting, and consumer-driven a plan. However, more generous interpretation of consumer-driven plans than previously mentioned, and the national health insurance. For instance, under defined-contribution plans, employees typically choose from a variety of health care options, with a specified amount of the premium paid for by the employers. One way to insure your staffs is direct contracting which is large employer’s contract directly with integrated delivery systems or of health care providers capable of accepting a financial risk and delivering a full range of health care services. (Nowicki, p74 & 75.)

Managed care's character in healthcare could modification. Increasing numbers of employers are transfer workers to high-deductible health plans, moving more costs to employees.

It’s a separate medical and disability reimbursement program which provides A 100% coverage for job-related injuries, illnesses or conditions arising out of and in the course of employment.

The Flexible Spending Account (FSA) is valuable to consumers, businesses, and policymakers it helps better assess returns on health care spending. If you have a health plan through employment, it can be beneficial to have a Flexible Spending Account (FSA) for copayments, deductibles, some prescription medication, and some durable medical equipment. Using an FSA can decrease your taxes that you pay. An FSA is an account an employee can put money into to pay for certain out-of-pocket health care costs, but you must use the money in an FSA within the plan year.

Little is known about the effect of these new plan designs with higher cost sharing on health care decisions. Because research has been limited to the few early adopters of these high deductible health plans, the experience is too new to draw definitive conclusions.

There has been a sharp increase in articles in recent years addressing ethics in healthcare with the rapid reforms and the millions added to healthcare coverage. The American Medical Association published just this month an article titled, “Ethics in Expanding Health Coverage through the private market”. (2015 #13). As this may not address specific compliance concerns, it does present an over all concern for the implications of the ACA, primarily being that this law does not guarantee coverage for all citizens and the subsequent burden placed on those who choose to purchase under its protection. The influx of funds to private markets gives them increased political power. It is the use of this power to examine and include into compliance

Approximately three quarters (74.5 percent) of patients had fee-based plans for their health insurance, which included preferred provider organizations (PPOs) or other comprehensive plans. Health maintenance organization (HMO) plans and point-of-service (POS) plans accounted for 11.3 and 13.4 percent respectively. A very small portion of patients were enrolled in consumer-directed health plans (CDHPs) or high-deductible health plans