Health Care Plan For Healthcare Care

1080 WordsJul 9, 20155 Pages
Managed care plans are the most common form of health care coverage offered in the United States today. One of the reasons that managed care plans have become so popular is because employers are the ones footing the bills for most medical coverage. Managed Care plans work off the basic premise that health care costs can be better controlled by controlling access to health treatments and services. The three main categories of managed care plans is HMO, PPO, and IPA. Health Maintance Organization Health Maintance Organization (HMO) is a type of managed care organization system, according to it provides a wide range of health insurance services through a network of hospitals, physicians, and other health care providers having a…show more content…
In this case they should be ready to deal with referrals and pay more a substantial deductible, co-payment, or coinsurance for the use non –panel providers. According to Mark & Mueller, (1996) “HMO members will pay premiums which is through an employer, which will be deducted from their paycheck, some employers may pay the premium costs for you”. Copayments in the other hand are received to cover medical services like emergency expenses or specialized care. Deductibles is the amount you pay out of pocket before the HMO starts while maximum out of pocket expenses is the maximum amount you have to pay for covered services during a certain period of time. HMO pays benefits only if you use physicians and hospitals within the plan’s network. HMO members normally do not have to file claims and wait for reimbursements. Preferred Providers Organization The preferred provider organization (PPO) is a combination of traditional fee-for-service and an HMO. Like an HMO, there are a limited number of doctors and hospitals to choose from, according to Muino, (1992) “a preferred provider organization (PPO) is a health plan that has contracts with a network of preferred providers from which you can choose”. In a PPO plan you do not need to select a PCP and you do not need a referral to see other providers in the network. If you receive care from a doctor in the preferred network you will be responsible for
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