Understanding Managed Care Plans

By Author: Marcus Stalder
Total Articles: 491
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When you're looking for a plan to insure your health with you usually come across different types of plans that all have their pros and cons, and are usually priced differently. Long gone are the times when you had only fee-for-service plans that were linked to the actual number of your doctor visits during the year. Managed care plans have proven to be more advantageous in terms of price both for the customer and the provider and today you will rarely find a person who's still using fee-for-service insurance.

However, when it comes to managed plans it's not that simple and the different types of plans available can deliver a certain degree of confusion, especially to a person who's not quite experience in insurance topics. In order to make things a bit easier for you here is a brief explanation of the main types of managed care plans. Analyze the advantages and disadvantages of every type and make sure to choose the one that brings most benefits to you and your family.

HMO (Health Maintenance Organization)

HMO is the most popular and widely spread types of managed health insurance and there are reasons ...
... for that. These plans tend to have the lowest rates and include free routine medical services such as checkups, exams, doctor visits, laboratory tests, etc. You pay a stipulated monthly premium and get coverage regardless whether you have visited the doctor or not. One of the main cons of HMOs is believed to be its in-network structure. When you get an HMO plan you have to choose a primary care physician that will refer you to all the specialists when you need coverage. You will also have a specified network of doctors and medical facilities that you can visit and get covered with. Going anywhere outside the network means that you don't receive any coverage at all and have to pay for the entire bill.

PPO (Preferred Provider Organization)

PPO health insurance plans on the other hand tend to be more flexible. You're not linked to a single doctor that will refer you to other specialists. You still are limited to a specific network of service providers, but you can go to any medical facility and get covered, only the covered portion will be lower than inside the network and you'll have to pay more. But you will have to pay for flexibility, as PPO plans are usually more expensive than HMOs.

POS (Point Of Service)

POS plans are somewhat of a mix between PPO and HMO plans. You get the benefits of PPOs when going out of the network as you still get coverage, only to a lesser extent. And you also benefit from choosing a primary car physician and getting your services within the network. It can be particularly useful for people who have long-term relationships with their family doctors and don't want to drop them for another doctor who is within the network.

As you see managed health insurance plans can differ significantly and depending on the type you choose you get different benefits with your plan. Make sure to think about your personal needs and choose the plan that is right for you!