Is there such thing as a managed care health insurance plan?

Managed care plans are fairly popular these days. There are several different options to consider with managed care plans, but choosing the right one for you can be challenging. It’s important to know each of the different types of health insurance plans and to make a choice that best encompasses your needs and your family’s needs.

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What are managed care plans?

According to MedlinePlus, managed care plans are when insurance companies have special contracts with doctors, hospitals and health care providers to provide care at a discounted rate for members.

There are three basic types of managed care health insurance plans to choose from. These are HMO health insurance companies and plans, POS (point of service) plans and finally PPO (preferred provider organization) plans.

What are HMO plans?

HMO plans have a network of providers and hospitals which are contractually bound to your health insurance company from whom you will receive all if not most of your health care. You are required to select a network primary care physician before your insurance takes effect and this person is responsible for managing your health care. According to the California Department of Insurance, HMO plans usually cover medical, hospital and surgical services that are discussed in the policy’s provisions.

Your primary physician will provide all the basic services for health care. The type of primary care physician you choose can be a family practice doctor, gynecologist, pediatrician, or even an internal medicine physician. In order to receive specialized care such as lab services or x-ray services your primary care physician must refer you. If you don’t have a referral your health insurance company will not pay for the services.

What are POS plans?

With POS plans you are also required to choose a network primary care physician. They become your point of service provider. Primary care physicians can refer you to outside the network providers if you need health care that they themselves do not offer. However, your health insurance company will only cover some of the costs from the outside of the network health care.

If you are using a specialist or your primary care physician within the network the paperwork is already completed for you. However, you’ll have to do your own paperwork if you go outside of the network.

What are PPO plans?

PPO health insurance companies offer plans that are similar to HMO and POS plans, but you do not have to choose a primary care physician. This also means that you do not have to seek out a referral to use another provider outside of the plan’s network of preferred providers. When using a preferred provider you’ll only have to cover your annual deductible and copayment. When using a provider outside of the network you’ll have to pay all costs yourself and file a reimbursement form to get a percentage back from your insurance company.

What are some of the differences between an HMO and a PPO?

With an HMO you can only use health care providers within the network. If you go outside of the network you’ll have to pay for it all out of pocket. With a PPO there still is a network of providers, but if you go outside the network you’ll have to pay some of the costs.

With an HMO you need a primary care physician and if you do not have one your plan will not cover your medical care bills. With a PPO you don’t have to have a primary care physician, but if you choose a medical physician outside of the network you’ll have to pay more than with those that are in your network.

To pay for services the HMO plan will only charge you for copayments from in network doctor’s visits and other services such as medications and any procedures. With a PPO you’ll be responsible for the copayment when using physicians within the network. Some PPOs have an annual deductable for services in or out of the network of providers.

What’s the difference between HMO and POS plans?

With HMO plans you’re only allowed to use the network of providers, however with POS plans you can be referred by your primary care physician outside of the network if need be. POS plans also have no health insurance deductible to calculate or pay. To receive medical services from a provider in the network, only copayments are required which are usually low in cost. There can be out of pocket deductibles on an annual basis with POS plans while HMOs only charge you for copayments.

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