Hassle-Free Health Coverage: Managed Care Plans
If you decide that an indemnity plan isn't for you, you may want to look into one of three basic types of managed care: PPOs, HMOs and POS plans.
A PPO or Preferred Provider Organization is the closest thing to an indemnity plan. A PPO contracts with doctors, hospitals and other providers who have agreed to accept lower fees for their services. If you choose a doctor within the network, you will pay a lower copayment (around $10 for a doctor visit or $5 for a prescription).
You can also go outside the network if you choose.
However, if you do go outside the network, you will have to meet the deductible and your copayment will be higher due to higher charges for services outside the network.
HMOs -- the oldest form of managed care -- offer a wide range of benefits, including preventive care, for a set monthly fee.
There are several kinds of HMOs. There are staff or group models in which you visit a plan doctor at central medical offices or clinics. Another type of HMO, an individual practice association (IPA), has network contracts with physician groups or individual doctors who have private offices.
HMOs provide you with a list of doctors from which to choose a primary care doctor, who will coordinate all your medical care. Your primary care doctor will be responsible for referrals to specialists.
Some HMOs require you to pay a copayment, usually around $5 to $10, for a visit. But many HMOs don't require you to pay anything.
If you belong to an HMO, it will cover only the costs for doctors in that HMO. If you go to a doctor outside the plan, you could end up footing the bill.
Point-of-Service (POSs) Plans are similar to indemnity plans in that you can still get some coverage if you go outside of the plan.
Although a POS requires you to choose a primary care doctor from the plan's network, he or she can make referrals outside of the network -- and your plan usually foots all or most of the bill.
In addition, a POS allows you to refer yourself to a provider outside the network and still find some coverage -- that is, if you are willing to pay coinsurance.
