Managed Health Insurance

Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations

Health care plans are policies created to aid the patients in accessing medical services in form of insurance to cover the expenses incurred during treatment and hospital care. In analyzing the options given by two major health care plans elaboration will be based on two major insurance schemes namely indemnity insurance plan and Managed Care plan. All these vary yet with a common aim of providing medical services to the patients. In order for the analysis, consideration will be based on the costs and the coverage. These two plans differ in many important ways, more so in regard to how the services are offered, the way to obtain special care and the cost of care after recovery. Despite the diversities, the two care types share many

What is managed care? According to the Oxford English Dictionary, managed care is “a system of health care in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company.” Managed care is a variety of techniques designed to essentially reduce the cost of providing health benefits and advance the quality of care. In the United States alone, there are various managed care programs, that span from less restrictive to more restrictive. As recently stated in the National Institutes of Health, the future of managed care is uncertain. It is enthralling to note that in spite of the advances in the health care systems, such as our hospital’s ability to provide patients

Managed Care is a complex health care system in which physicians, hospitals, and other healthcare professionals organize in an interrelated system of people and facilities that communicate with one another and work together as a unit, commonly referred to as a network. This network coordinates and arranges health care services and benefits for a specific group of individuals, referred as enrollees, for the purpose of managing costs, quality, and access to health care. The Managed care program may be provided in a variety of settings, such as Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). In Health Maintenance Organization, the insurance company will only pay for care within the network. The member will pick a primary care provider who coordinates most of their care. Preferred Provider Organization (PPO) usually pays more if the member will get care within the network, but they still pay a portion if the member will go outside. And Point of Service (POS) plans let you choose between an HMO and a PPO each time you need care (Merrick, 2013).

Americans that are insured receive their health care from managed care plans that are either HMO’s or, PPO’s (Preferred Provider Organizations). Most Americans are forced into managed care by their employers due to companies offering one managed care option or, worse no insurance at

The three types of managed care plans include, Health Maintenance Organization (HMO), Preferred Provider Organizations (PPO), and Point of Service (POS). With the HMO plan, a primary care doctor is chosen, and coverage is for care provided within the network. The PPO plan pays more if care service stays within the network, than it pays if care is done outside of the network. Furthermore, the POS plan allows the patient to choose between the HMO and the PPO, for each visit to the doctor (healthychildren.org).

If you are enrolled in a health maintenance organization (HMO) you will need to receive most or all of your health care from a network provider. HMOs require that you choose a primary care physician (most often an internist, family doctor, or pediatrician for your children) who is responsible for managing and coordinating all of your health care.

You will need to clarify the kinds of coverage your insurer will provide. Different kinds of plans will only cover a specific number of healthcare services. For example, you will need to check whether or not the healthcare insurance plan you are going to choose, will include dental care or not. Not all doctors and hospitals will be covered by one company. So check on where and who is covered by the insurance plan, you are considering getting.

Third-party payers are significant in healthcare. Many individuals do not have enough money to compensate for healthcare facilities out of pocket. Third-party payers contain insurance firms, administrative agencies, and managers. Managed care plans are a kind of health assurance. They have agreements with health care workers and medical amenities to offer care for associates at reduced prices. These benefactors make up the plan's system. Health Maintenance Organizations (HMO) typically only charge for attention within the system. You select a primary care doctor who organizes most of your upkeep. Preferred Provider Organizations (PPO) typically charges more if you get care within the system. They still pay a portion of the fee if you go separate

Health insurance in the United States is very dynamic and costly to most citizens; however, it is necessary to ensure healthy living and protection from outrageous debt owed to health providers. With the recent changes due to the Affordable Care Act started by President Barack Obama, people now are being pushed to get health insurance.

It has been understood that health care coverage is important. So important that not having health care insurance can place an individual at major risk health care wise. These risk could be minimized by simply purchasing health care insurance. There is not just one type of health care insurance but there are several types in which will accommodate the needs of the patient and what he or she may be able to afford. With many varieties with coverage plans like Point of Service (POS), Preferred Providers (PPO) and Exclusive Provider Organization (EPO); Health Maintenance Organization (HMO) is the most preferred health insurance plan by companies. While finding what plan is best for each group it is important to minimize risk and maximize companies

Insurance, most notably health insurance, has become a major part of the American lives. Health will always be a major concern for people, so health insurance would be the most bought insurance. Sometimes people get sick unexpectedly, people will usually be thankful that they have insurance but not really know how their insurance works. It is imperative to know how one’s insurance works so one can pick the best plan that will benefit them without being overcharged for services that they do not need. There are three types of insurance plans that are widely used by health insurance companies. They are: FFS (Fee-For-Service Plan), HMO (Health Maintenance Organization), and PPO (Preferred Provider Organization). FFS plans is a little older than the managed care plans, HMO’s and PPO’s, however they are still used today. HMO’s and PPO’s are the most popular health insurance plans used by the insurance companies.

Valerie, I agree with your reasoning on the goals behind the creation of managed care plans. I think the reason they are more affordable is because of the emphasis on prevention. By having patients receive preventive care providers can identify problems at an early stage therefore controlling the cost associated with illnesses. I think it's much cheaper to go to the doctor for a well-check up oppose to going when you are sick. "By contracting with various types of MCOs to deliver Medicaid program health care services to their beneficiaries, states can reduce Medicaid program costs and better manage utilization of health services." ("Managed Care | Medicaid.gov,"

An issue must be placed on the policy agenda and must be given a great deal of governmental attention. While the idea of promoting health care reform may have been fabricated up as a political maneuver, there was considerable support for changes to the existing manner in which health care is provided in the United States among many Americans and their elected officials. The task was enormous, and the implications yet to be fully determined, but the 2,000-page bill that

The United States is currently a mess when it comes to health insurance. Everyone needs health insurance, but we need to remain at private health insurance because if we don't have the money to fund for it then we'd be without health insurance. Research shows that we aren't getting our money's worth when it comes to health insurance.