Managed Care Types

Managed Care Types:

There are three main care types that employers will look at to see if the employees need to be provided with. The three types of cares are medical, dental, and vision. The main focus of cares that can be provided is medical care. The medical plans that will be discussed are the HMO, PPO. POS, MSA and Medicare. These plans are similar in the fact that each one is a type of health insurance and provide medical for employees are retirees. Choosing health care coverage can be far more complicated than choosing a new car.Each has its unique features varying by premiums, selection of doctors and specialist seeking.

HMO

HMO’s is a Health Maintenance Organization is the most controlled health care plan. Members are required to pay a fixed monthly fee called a premium and have the responsibility to pick a PCP from the plans network. The list of doctors, places that offer care are limited to the plans own network. If the member wishes to see a specialist the member has to be referred and see the referred specialist for care. If the member does not want to see the referred specialist that is in the network the coverage does not extend to outside side coverage and the member would pay full price. Even though freedom is given up to be able to choose; however, out of pockets expenses is very low. For regular doctor visits the member has to pay small co-pays generally around $10.00 to see the PCP. Prescriptions if needed are covered and will be a $10.00 per prescription basis. Other drugs may or may not be covered under the plan and it will have a preferred prescription drug list to show what is available in the plan.

POS

A POS is a point of service plan that acts like an HMO except under a POS the member can choose the PCP and hospitals that are in the network and have the option to go out of the network when the members wishes to at a higher deductible. The employee can choose how to receive services until one is needed. The member will follow the guidelines covered under an HMO paying the required co-payment. Visits are an out pocket $10.00 and $10.00 co pay for specialty care. Generic prescriptions drugs are the same cost of the HMO of $10.00 per order. If the member wants to travel outside the network it must first meet the deductible and then pay a percentage of the expenses.

PPO

A PPO is a Preferred Provider Organization that negotiates with doctors and hospitals to reduce the amount of money that members have to pay. This type of plan has a larger list of doctors and hospitals to choose from and does not require its members to select a PCP. PPO’s are more expensive than an HMO, but allows for its members to have specialty care with no referrals needed. If the member decides to go to an out-of-network provider the member must pay the difference between what the provider charges and what the plan pays for a medical service. Using the out-of-network care can be more expensive; however, it allows for the freedom of choice.

MSA

you are self employed and you apply and are approved for one of these health plans, then you are eligible to get a "Tax Qualified" special bank account called an "MSA". This allows you to pay for healthcare expenses with pretax dollars. Not many banks offer these special bank accounts but here is a link to one that does: