Although health insurance is broken down into two main broad categories, traditional and managed care, the types of health insurance are so many that they confuse very many people.
The traditional health insurance is also known as free-for-service. Individuals pay up part of the medical bill in form of a deductible and the insurance caters for the remaining larger sum of the total bill. This health coverage gives its users the autonomy to settle for doctors, hospitals, and other health care providers of their choice. They do not decide the necessity of a visit, nor do they demand permission before referring a policyholder to a specialist. However, to some extent there are some limitations. Free-for-service manages medicine to some extent. For instance, they require people to get clearance before visiting the emergency room, if they are not in a critical state. Free-for-service insurance also features preventive care services and annual check-ups in their coverage. The major downside to the traditional health insurance plan is that it involves more out-of pocket expenses. They usually charge a deductible before they start paying a medical bill, and end up catering for about 80% of the total medical bill. These health plans only cater for the customary and reasonable medical cases. If the consulted doctors charge much higher that the reasonable and customary considerations of the insurance policy, individuals would most definitely be forced to make up the difference. They provide a ceiling that is meant to cater for the out-of-pocket expenses so that they end up paying 100% of the medical bill; however, this fee is usually substantially high.
Managed care health insurance has also been around for long, although it gained popularity around a decade ago. Most people with private health insurance feature some sort of managed care. The different types of managed care insurance feature numerous differences, and a few common factors like the significant financial benefits offered to policyholders. They also feature an arrangement between policyholders and a selected network of healthcare providers. Managed care incorporates explicit standards when selecting providers and carry out a formal procedure to uphold quality healthcare. Some types of managed care insurance include PPOs, HMOs, and POS.
Health Maintenance organizations only give access to specific doctors and hospitals referred to as networks or providers. Signing in with this insurance plan requires on to select a primary care physician (PCP) from a given list.
Pont-of-Service health insurance plans are similar to PPOs in all aspects, except for the fact that they feature a gatekeeper or a Primary Care Physician. To get a referral to a PCP one has to go through a PCP. Referral from a PCP to an outside doctor gives one the benefit of getting all costs fully covered. These insurance plans also cater for preventive care services and offer health improvement programs like smoking cessation.
Participating Provider Options feature a network of doctors, specialists and hospitals although one is not obligated to choose a PCP. They feature lower fees and are flexible as they give the option of receiving care from doctors within and outside the network. In addition, on does not need a referral before consulting a health practitioner. PPOs give policyholders financial incentives to stay within a particular network.
Having a health insurance is necessary for everyone considering the rising cases of health-related problems, potential medical conditions, and the cost of medical care. Addressing medical cases is almost impossible without a health insurance policy. However, people should go through the policies in detail before determining the one that suits them best.