Health Insurance Coverage
What kinds of health insurance are there?
There are essentially two kinds of health insurance: Fee-for-Service and Managed Care. Although these plans differ, they both cover an array of medical, surgical and hospital expenses. Most cover prescription drugs and some also offer dental coverage.
These plans generally assume that the medical professional will be paid a fee for each service provided to the patient. Patients are seen by a doctor of their choice and the claim is filed by either the medical provider or the patient.
- Managed Care
More than half of all Americans have some kind of managed-care plan. Various plans work differently and can include: health maintenance organizations (HM0s), preferred provider organizations (PPOs) and point-of-service (POS) plans. These plans provide comprehensive health services to their members and offer financial incentives to patients who use the providers in the plan.
What kind of health insurance will be available with the PPACA?
There will still be two kinds of health insurance come January 1, 2014: Fee-for-Service and Managed Care. However, they will come in a variety of forms and will be found both inside and outside of the new Marketplace known as Covered California.
- Preferred Provider Organization (PPO)
With a PPO, you can choose your provider and you do NOT have to get a referral to see a specialist. If you use a provider that is within the provider network, you will have lower out of pocket expenses than if you use a provider that is out of the provider network.
- Exclusive Provider Organization (EPO)
Very similar to a PPO, except there is no coverage out of network, except in emergency situations.
- Health Maintenance Organization (HMO)
In an HMO, you are required to have a Primary Care Provider (PCP) who manages your entire healthcare. Any referrals to specialists must come from your PCP. Generally, there is no coverage outside of an HMO network except in emergency situations. Most HMO’s are also regional and may not be available in all areas.
- Health Savings Account (HSA)
These are high deductible plans and qualify to be paired with a special savings account that allows you to pay for your healthcare with pre-tax dollars.