Similarities and Differences Between Managed Cares
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 procedures to acquire quality care (Types of Insurance, 2010).
The three major type of manage car plans include Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Point of Service (POS). HMOs are a prepaid basis provider, where there members pay a fixed monthly fee, regardless of the medical care needed monthly. The medical service provided by an HMO can vary for office visit to hospitalization or surgery. Member can only receive medical treatment from the in-network physicians or facilities. HMO member can only be referred by an in-network physician to a specialist. Choosing an HMO provide a significant out of pocket savings to their members when see in-network physicians (Senterfitt, 2005).
A PPO is a group of doctors and/or hospitals that provides medical service at discounted rates and may set up utilization control programs to help reduce the cost of medical care. Members are not required to sign up with a Primary Care Physician (PCP). Rather than prepaying for medical care, PPO members pay for services as they are rendered. A co-payment is required and the member may consult out-of-plan facilities at a higher co-payment. A Point of Service
(POS) plan combines characteristics of the
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 procedures to acquire quality care (Types of Insurance, 2010).
The three major type of manage car plans include Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Point of Service (POS). HMOs are a prepaid basis provider, where there members pay a fixed monthly fee, regardless of the medical care needed monthly. The medical service provided by an HMO can vary for office visit to hospitalization or surgery. Member can only receive medical treatment from the in-network physicians or facilities. HMO member can only be referred by an in-network physician to a specialist. Choosing an HMO provide a significant out of pocket savings to their members when see in-network physicians (Senterfitt, 2005).
A PPO is a group of doctors and/or hospitals that provides medical service at discounted rates and may set up utilization control programs to help reduce the cost of medical care. Members are not required to sign up with a Primary Care Physician (PCP). Rather than prepaying for medical care, PPO members pay for services as they are rendered. A co-payment is required and the member may consult out-of-plan facilities at a higher co-payment. A Point of Service
(POS) plan combines characteristics of the
References: Healthinsurancequotedever.com. (2009) Health Insurance in the United States of America Retrieved April 21, 2012, From http://individualhealthinsurancequotedenver.com/health-insurance-united-states.html Senterfitt, B. (2005). Material differences exist in HMO vs. insurer regulations. Managed Healthcare Executive, 15(5), 12. Retrieved April 21, 2012, from ABI/INFORM Global. (Document ID: 840744471). Quickquote.com. (2012). Types of Health Insurance. Retrieved April 21, 2012. From http://www.quickquote.com/hitypes.html