| Health insurance is a necessity for all | | | | your premiums. |
| individuals. This is because even a minor | | | | |
| illness can quickly become a life threatening | | | | Managed care plans use "networks." This means |
| condition that you can cost thousands of | | | | that you have to choose from a specific list |
| dollars to treat. Many illnesses have been | | | | of doctors, clinics, hospitals and health |
| financially devastating to many people and | | | | care providers. These providers are |
| families and having adequate health care can | | | | contracted with your plan to provide services |
| assist you in covering those medical expenses | | | | to members of the plan. Some managed care |
| as well as helps to ensure that you can | | | | plans will require that use only providers in |
| afford preventative medicine as well. | | | | the plan for your routine care. Others will |
| | | | pay for care from any provider, but offer you |
| It is important to understand how health | | | | more financial incentives for sticking with |
| insurance coverage works before you purchase | | | | those in the network. |
| a plan. The health insurance plan that you | | | | |
| choose must meet your needs as an individual | | | | Managed care plans are usually a more |
| or family. There are several different types | | | | affordable option. Managed care networks |
| of health coverage available and having an | | | | provide healthcare professionals with |
| understanding of health plans can help you | | | | "built-in" clientele, thus allowing them to |
| choose the right one. | | | | lower their rates. These plans also emphasize |
| | | | preventative care to keep medical conditions |
| Health care plans will typically pay for | | | | at bay. In general, the trade-off for these |
| most, and possibly all, of the cost of | | | | programs is that you may not be able to use |
| treatment for illnesses and injuries. These | | | | your doctor of choice, but you will receive |
| are usually classified as "managed care" or | | | | increased affordability. |
| "fee for service." | | | | |
| | | | There are three types of managed care plans |
| Most people are familiar with "fee for | | | | including: |
| service" plans and they are often referred to | | | | |
| as "indemnity plans." These are plans that | | | | Â- Preferred Provider Organization Plans - |
| are sold by traditional insurance companies | | | | These allow you to go to any provider you |
| and you can go to any doctor you want and you | | | | wish, but you will save if you use providers |
| don't require a referral if you need a | | | | that are in the network. You do not have to |
| specialist. A fee-for-service plan will often | | | | select a primary care physician for a PPO |
| pay for most of the costs of treatment for | | | | plan. |
| medical conditions that are covered in the | | | | |
| policy. In most cases, your healthcare | | | | Â- Health Maintenance Organizations - These |
| provider will bill the insurance company | | | | require you to only receive care from |
| directly for the cost of your care, but in | | | | providers within the network. There are |
| some instances you may have to pay the bill | | | | exceptions should a medical emergency occur. |
| and then file a claim for reimbursement with | | | | With a HMO, you will have to choose from a |
| the insurance company. With a fee-for-service | | | | "primary care physician" list. Your physician |
| plan, you will be required to pay a premium, | | | | will oversee your medical care and provide |
| deductible and coinsurance. | | | | you with referrals to specialists and other |
| | | | providers you may need. |
| Co-insurance is the portion you have to pay | | | | |
| once you have met your deductible and the | | | | Â- HMOs with a POS (Point-of-Service) - If |
| plan begins to pay benefits. Generally, your | | | | this will allow you to use a healthcare |
| plan will pay 80% after the deductible has | | | | provider outside of the network, without |
| been met, but you are then required to pay | | | | first having to receive a referral. However, |
| the leftover 20%. The amount that the | | | | you will pay more for using those providers. |
| insurance company pays depends widely on the | | | | A POS plan may also exclude the option for |
| state you live in. As with a deductible, the | | | | out-of-network care in certain medical |
| higher you pay in co-insurance, the lower | | | | situations. |