Similarities and Differences Between Managed Cares Essay

701 Words May 2nd, 2012 3 Pages
Similarities and Differences between Managed Cares
Verletta Williams
Everest University Online

Managed care has been formed since the 1930 and evolved over the last ten years. Since the evolving of managed care there are three types of managed care plans. People that are enrolled in private health insurance are subscribed to a type of managed care plan. There are many differences between the three types of managed care plans and they also have similarities. The involvement of managed care plans are between the insurer and the selected network of health care providers, and the policyholder’s financial incentive that are used by the providers in the network. There are precise measures for choosing a managed care plan and conventional
…show more content…
However, the member must choose a primary care physician who is responsible for all referrals within the POS network. If the insured opts to go outside the network, POS coverage functions more like a PPO. She/he may be subject to an annual deductible (around $300 for an individual or $600 for a family), and the co-payment may be a substantial percentage of the physician's charges (usually 30-40%).
An HMO is similar to PPO but the physicians consulted must be part of the plan. With a POS plan if you’re PCP needs to refer you to an out-of-network physician the plan will cover majority of the cost. When you’re referring yourself to an out-of-network physician there is more paper work required and smaller reimbursement. The member will be responsible for paying a deductible for out-of-network coverage. A PPO managed care plan differs from HMOs and POS plans in several important respects. First, it does not actually assume the risk of insuring members. Secondly, it offers customers a much wider range of physicians than the typical HMO can.
An HMO may have central medical offices or clinics (such as those used by Kaiser Permanente), or it may consist of a network of individual practices. In general, you must see HMO-approved physicians or pay the entire cost of the visit yourself. HMOs have the best reputation for covering preventive care services and health improvement programs (Quickquotes.com, 2012). With a PPO plan it
Open Document