Health Insurance

It wasn’t that many years ago that doctor’s house calls and the milkman became obsolete. Now health care coverage plans are old before you can even get to use them. In response to the dramatic increase in medical costs, companies are constantly developing and improving to save you money on your health care and try to control health providers’ costs and still provide top quality coverage. New and innovative features are now being developed, including:

· Facilities and physicians contracting with health care companies for discounted fees.
· Using financial incentives for people to maintain their own health.
· Making care convenient for both the insured’s and health care professionals.

“Managed Care”

Managed Care is how the new plans keep health care costs and premiums under control by changing the way you get and pay for from lab test and exams, to prescriptions and having kids.

Many people are familiar with “Managed Care” in the form of health maintenance organizations (HMO’s) and Preferred Provider Organizations (PPO’s). At the start of 1997, HMO’s, PPO’s and exclusive provider organizations, and point-of-service (POS) plans had more than 150 million people insured. HMO’s, PPO’s and similar systems like a POS, encouraged you to visit pre-selected facilities and doctors by offering substantial savings.

The “Managed Care” system has two additional features that are important in helping to keep costs down and to control the rise in premium rates. The first is hospital pre-admission certification, which confirms that a hospital is the best place to get the care needed. The second cost cutting feature is a continued stay review, which confirms the necessary length of time in the hospital.

When thinking about becoming an insured member with a managed care system there is one basic difference between an HMO and a PPO. In a word, flexibility.

A PPO gives you a list of preferred physicians, specialist, etc., who are “in-the-network”. The in-network system lowers your out-of-pocket expenses for the benefits you receive, but may require changing health care professionals and possible going out of your way to get care. But unlike an HMO which is more restrictive, a PPO still pays benefits for covered services even if you visit a health care professional “out-of-network” or outside of their official list. This is comforting if you have a favorite doctor or if there are no PPO providers where you live. You should still get reimbursed for covered services rendered, although at a lesser rate than if you visit a health care provider within the PPO network.

If premium is the primary concern, you can stick with the traditional “indemnity” plan and still reduce your premiums with your 80/20 plans by switching to a higher deductible. As long as you are generally healthy, you will come out ahead. But like the milkman and the doctor’s house call many people are moving to the PPO plans that also provide the higher deductibles.

To learn more about your options or for a free quote click below.