4 Major Types of Healthcare

Health & FitnessCancer / Illness

  • Author Stefan Wright
  • Published February 4, 2011
  • Word count 566

Is it time to choose the right healthcare insurance coverage? Well it's fantastic that you decided to do your research first! Don't get a poor coverage by making a rapid decision.

Well to help you with your decision, and will help ensure you get the right coverage given your health and wallet. Firstly, access your budget as well as your health. The cost of healthcare continues to rise annually, and with the overall increasing life expectancy, it's vital to have the right coverage.

Coverage can be grouped into four major categories. They are: Major Medical, HMO, PPO, and POS.

The Major Medical Coverage:

This is a very common healthcare coverage. The insured pays ahead of any medical expenses in a form of a monthly deductible. Should the need arise, the covered member can go to whichever medical examiner they want, employ their services and pay them directly. Afterwards, when they provide the insurance company with a claim, their costs will be partially reimbursed for up to 80% of the cost of healthcare. Alternatively the insured member can opt to sign a release, to have the insurance provider pay the healthcare provider directly. But there is always some amount that has to be paid by the insured party.

Second is the Health Maintenance Organization (HMO):

What sets it apart from the Major Medical plan, the HMO provides a slightly different method. A lot of the time it is cheaper, but as a result the options are limited, forcing the insured party to select a primary physician from a network. It is that medical practitioner's task to provide preventive care and coordinate care with any specialists that too are in that network (and even hospitalization whenever necessary). If it happens that the practitioner is not in the network, they will not be covered. To further manage the costs certain medical treatments are deemed unnecessary and are therefore not covered.

Another popular option is the Preferred Provider Organization (PPO):

You can think of this as something midway between Major Medical and HMO. With PPO the insured member has the choice to choose any medical professional to provide treatments, though a list of predetermined specialists is also provided. This impacts the costs to the plan holder. The deductibles to the insured person are lowered when they select a treatment from a specialist on that network. Coverage of treatment is still reimbursed, to 80% of the cost of the medical service. But to 80% of the cost that was determined by a physician that is in the network. That is, it's not 80% of the cost, but of the acceptable cost. This amount tends to be a big greater.

Fourth kind is Point Of Service (POS):

To balance cost and coverage; a compromise between a HMO and a PPO plan; there is POS. It offers greater freedom, while the management of costs is improved on the insurer's end. The plan holder has to select a single specialist and go to that physician for all health care needs. The physician may refer the plan holder to a specialist that may or may not be of the network of specialists. In this case, unlike the HMO, even if the doctor is outside of the network, the fees will still be reimbursed by a predetermined percentage. In the event that treatment is acquired without a referral, then the insurer may choose not to reimburse for those medical expenses.

This article has been viewed 738 times.

Rate article

Article comments

There are no posted comments.

Related articles