Similarities and Differences Between Managed Cares Essay

As far as insurance plans go, generally there are three plans a patient will have, they are Health Maintenance Organization (HM0), Preferred Provider Organization (PPO) and Point-of-Service (POS).

Another type of managed care program that was introduced is the Preferred Provider Organization (PPO). A PPO is comprised of a group of physicians, hospitals and other medical service providers who contract with employers, insurance companies or other plan sponsors. The PPO offers discounted pricing to these contracted organizations due to the high volume of business received. PPO’s typically have up-front cost sharing in the form of deductibles and/or co-insurance, which vary depending upon the actual plan chosen.

Point-of-service (POS) health insurance combines several elements from both HMO and PPO plans. Similar to health maintenance organization plans, (HMO), a member is required to choose a primary care physician and seek referrals to network specialists. Like preferred provider organization insurance, (PPO), members have the choice to receive care from non-network providers but typically incur larger out-of-pocket costs for venturing outside the network.

The same is true of POS plans and indemnity plans. The first plan is a combination of HMO and PPO type plans, by requiring a primary physician whom must approve all coverage, but also allowing you to get coverage outside of your network.

Medicare is a federal health insurance program for people sixty- five or older, also there can be younger people with disabilities, and people with End-Stage Renal Disease. Medicare splits into two segments. Segment A concerns inpatient hospital, skilled nursing facility care and home health care. Once officially registered in Medicare, you will be given these benefits instantly and won’t have to pay premiums for them, because you’ve already paid for them through your taxes. Segment B concerns majority of your medically necessary doctors’ services, preventive care, durable medical equipment, etc. You will pay a monthly inducement for this coverage. Segment C concerns of Medicare policy that permits private health insurance companies to equip. HMO’s and PPO’s (Medicare private health plans) are acknowledged as Medicare Advantage Plans. You have the choice to choose Medicare Advantage Plan in place of going through Original Medicare. Segment D concerns Medicare that

HMO is an organization that provides or arranges managed care for health insurance, individual and other entities in the United States. It existed prior to the 1970s, which required employer who has 25 or more employee to offer HMO healthcare. In most of HMO plans, it required the insurers to select a primary care physician (PCP) who is responsible for all their healthcare services. If they need care from a physician specialist in the network, their primary care physician will have to provide them with a referral. If they don’t get the referral or they select to go to see a doctor outside of your HMO’s network, they will most likely have to pay all or most of the cost.

You can choose between an HMO or a PPO each time you receive medical care. These plans offer more flexibility in choosing doctors and hospitals.

I agree with you a PPO plan will be a good choice for a family. PPO plans allow its members to use out-of-network providers for a higher copayment or increased deductibles, whereas an HMO plan allows only HMO network providers. PPO plans have discounted fees as well. In addition, in PPO plan, referrals to specialists are also not required. PPO plans do not have stringent guidelines like HMO. However, PPOs may require preauthorization for nonemergency hospital admission and for some outpatient procedures. Although preauthorization is required by most of the managed care plans. There are differences of cost and benefits for each of the managed care

With and HMO plan you have one primary care doctor approved by your plan who manages your cares for you through referrals and assistance on getting appointments with specialists. These plans

HMO is a cost-effective plan since you must choose a primary care physician and need a referral to see a specialist since they are coordinating the care it will lower the out of pocket expense. As for PPO is one stays in- network they may only be responsible for a co-pay. The way that POS works are that it has some features of both the HMO and the PPO however since options are limited this is how they can keep the cost low. As for a recommendation, it would depend on the needs of the individual and how much control they prefer to have their health insurance in regards to what doctor they prefer to see. I believe the PPO plans offer more flexibility and would be the best option since it does allow the opportunity to save while not limited on

Many have felt that the intentions of this new enactment were to prevent Americans from receiving the proper care that is needed. However, within managed care organizations is the ability to provide all those Americans with better and more affordable care. The formation of managed care organizations grew rapidly during the Great Depression, “not because consumers were demanding insurance against the risk of medical expenses or because nonphysician entrepreneurs were seeking to establish a business, but rather because providers wanted to maintain and enhance patient revenues” (Kongstvedt, 2). There was a major increase to company wide health care organizations when the government decided to enact the federal Health Maintenance Organization Act. This act “authorized start-up funding and ensured access to the employer based health insurance market” (Kongstvedt, 4). Many advocates of managed care organizations like to point out that, “managed care is unique in that it did not arise out of a specific legislative initiative but instead represents a market response” (Health Care Manager, 54). From this we are better able to understand that the wishes of consumers of traditional health care programs felt that something needed to be improved for success. Now that we know where managed care started, we can venture in to how it has evolved throughout the

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

Let’s take PPO’s and HMO’s plans and compare the difference. The word “preferred” means that the plan is designed to have contracts with doctors and medical facilities that perform services for their members at a lower rate than the non-members and a referral does not need to be obtained in order for the patient to see a specialist (Pearson 2015). This means that a consumer will not have to compromise between searching for the best physician and searching for what is affordable. Then we have the HMO plan which is the most affordable plan and has a lot more benefits to offer than the PPO plan, but it does come with restrictions for those patients with serious health conditions. HMO’s offer very limited and strict network of physicians and other healthcare professionals with limitations on what is covered by the plan and many patients have to pay out-of-pocket expenses if services are not within the network. Overall, this plan is lower than the PPO plan but it has many drawbacks. Before choosing a healthcare plan, be sure to

A HMO is an insurance plan that that is more to accommodate your finical needs but there are restrictions on which doctors that you can see and you also pay a fixed monthly fee, but unlike the PPO you are not required to file a claim with your insurance provider. A PPO is a little bit more flexible, fewer restrictions, and that also comes with a higher cost. You would also be covered under the PPO if you go outside of your insurance network plan and unlike the HMO the PPO requires that you file a claim with your insurance provider. I would chose to go with the HMO insurance plan simply because not everybody is the richest person in the world and we all know that money does not simply grow on trees, some

HMO stands for health maintenance organization , with this health plan you can select your primary care physician who will be responsible for your basic healthcare needs. If you need a referral to see a specialist your PCP has to send a referral over. Note the referral of the specialist must be within the HMO network. If you would like to see a doctor that is considered outside of the network or without a referral, you will brunt the cost, you will be responsible for all out of pocket cost, unless it a medical emergency and you have no other choice.