Managed Care Health Insurance Plans
Managed care health plans work as a network or group of medical professionals and hospitals that are contracted with the health plan. This helps insurance companies and health care providers work together to give patients the care they need. Usually, a managed care plan requires that its members only obtain services through doctors and hospitals that are in their network. Basically, you are more limited in choosing your health care providers, but the advantage is that you save money. Most health insurance providers in Texas use managed care plans.
A managed health care plan is usually cheaper than fee-for service plan. For health care insurance in Texas, their reasoning for charging lower rates is because their hand picked medical personnel and facilities. They allow low rates for these kinds of plans. This plan also focuses on taking care of yourself so that you can avoid getting sick unnecessarily.
Managed care providers offer three different categories of health insurance in Texas:
HMO (Health Maintenance Organization) – The HMO is unique in that it requires the patient to choose a Primary Care Physician (PCP) and work directly with that doctor for all care. Patients must see their PCP before visiting a specialist, receiving tests or being admitted to a hospital to get the PCP’s (and insurer’s) approval. The PCP will refer patients only to doctors within the HMO’s network and patients pay a co-pay for office visits but there are often no deductibles. The HMO is generally the least expensive choice in managed care.
PPO (Preferred Provider Organization) – This plan allows you to see any doctor you choose. The only disadvantage with this is that if the doctor is outside of the network, you will have to pay more. With health care insurance in Texas, it is strongly encouraged that people use a doctor within the network.
POS (Point Of Service) – This optional plan allows you to use doctors and other medical services outside of the HMO network. Also, you are not required to get a referral. Doctors and other providers used outside of the network will require you to pay more, even for health care insurance in Texas.
Most health insurance options in Texas will require you to pay some type of premium, even with employer sponsored plans. Sometimes you will have to pay your entire deductible before the insurance will cover a single dime even for surgery or emergency room visits. Your deductible the amount you have to pay before your benefits kick in. This is one of the factors you want to consider when choosing a health care plan.
Co-pays are another cost consideration for anyone choosing a health insurance plan in Texas. You usually need to cover your co-pays for every doctor and hospital visit and when filling prescriptions, even once you meet your deductible. With several managed care insurance plans (especially an HMO), there are limits to a patient’s out-of-pocket annual expenses so costs do not get out of control.
Since there are so many variables involved with health insurance plans, it is important to consider your choices wisely before making a decision that can have a dramatic effect on your physical and financial health over the years.
