There's no single perfect plan that will cover all costs associated with medical care, but some cover more than others. Here are some Differences in the types of coverage.
Types Of Coverage:
Fee-for-Service(or Indemnity) Plans:
This is a very traditional plan in which you can make an appointment with almost any provider. When your visit is through either you or your provider sends your claim to the insurance company. If you've already met your deductible for the year, then the Fee-for-Service plan will pay a percentage of the bill-most often 80%. Then your responsible for the remaining 20% which is called co-insurance.
Managed Care:
This term refers to types of insurance plans that provide health care services at a lower cost. In order to keep these cost down members must adhere to certain rules and guidelines.
Types of Managed Care:
Health Maintenance Organizations (or HMOs)
With an HMO, you recieve a range of health benefits for a set fee. Usually, there are no deductibles- however most plans do require a small copay per office visit (about $10-25). It's also mandatory to choose a primary care physician from the plan's list. This doctor will be your doorway for all your medical needs. You must see this doctor first when your sick and they will refer you to a specialist or other provider within the HMO network. With most HMOs you will not receive benefits if you go out-of-network except for emergency care.
Types of HMOs:
*Staff Model HMO
A form of HMO where doctors are employees of the HMO and you see them at a central medical facility.
*Individual Practice Associations (IPAs)
Here, an HMO contracts with outside physician groups or individual doctors who have private practices. The HMO network will include doctors in various locations rather than only at a central facility.
More Types of Managed Care:
Preferred Provider Organization (PPO)
This isn't an HMO, but it is another type of managed care. In this organization you may search out treatment from an approved network of providers, or you may choose to use other providers outside of the network. Most often you will pay a small copay and/or meet your deductible before benefits are provided. Then you'll pay a set co-insurance amount. Although you may go outside of the network keep in mind your portion of the bill will be higher.
Point of Service (POS):
A hybrid of the HMO and PPO is known as a POS plan. Just like a standard HMO, you have a primary care physician who makes referrals to specialists or other providers within the plan. Now if you decide to go to someone outside the network, without first consulting with your primary care physician, then the POS plan will pay a predetermined amount of the bill and your portion of the bill will be higher than if you had.
When chooseing between different insurance plans it's good to compare how each of the plans can handle-
*Co-payments
*Co-insurance
*Deductibles
*Pre-existing conditions
*Limitations on devices, drugs, coverages and access to specialists
