Health insurance in the United States is based on premises of sound financial security for better healthcare management for its civilians under different categories and conditions. Some of the popular insurance plans are run by the government itself or it backs up legal conditions for the private insurance companies to facilitate quality health care. You can know about insurance plans as under:
An indemnity plan, also referred to as fee-for-service plan, is the most conventional type of health insurance covering healthcare expenses for current medical conditions of patients. It is fairly expensive but offers them maximum flexibility and freedom to select healthcare provider of their own choice.
- There is no need to bother about in-network or out-of-network providers. The patient can choose any physician and/or health care facility.
- The patient pays to the health organization or physicians and fills claims separately.
- Preventive care is usually not covered and copayment is also paid by the patient.
- The insurer has little control over the medical expenses because of non-negotiated medical services rates.
Managed Care Plans
Managed care plans are designed to target complete health care of its consumers. It typically covers the costs of treatment of the medical condition along with preventive care and provides guidance for minimizing the risk exposure.
- The insured is usually not free to choose physician or health care facility out of network. Under some circumstances, a recommendation from personal physician appointed by managed care plan is required for getting special medical services.
- Preventive care is usually provided free of cost and includes routine checkups, immunizations, guidance and counselling.
- No deductible are associated with this insurance plan.
- The insurer can study the treatment pattern and the medical costs associated with it.
- Added benefits of both managed care and indemnity health plans.
- No need for pre-authorization to visit or take treatment from physician or health facility out of network.
- Easy and better cost coverage if recommendation is sorted before the treatment.
- Manual paperwork and high out-of-pocket expenses and low coverage, if the patient chooses the out-of-network medical services without pre-authorization.
High Deductible Health Plans
In 2003, High deductible health plans first introduced in the market as a viable alternative to managed care plans that assure consumers with low deductible but claim high premiums.
- Works along with Health Savings Account (HSA) or Health Reimbursement Agreement (HRA).
- Your income level settles on whether you have the eligibility for an HSA or an HRA.
- The High deductible health plans with HSA or HRA is an extremely flexible for handling your health care benefits. The funds from the HSA or HRA can be used to pay deductible or from pocket to keep the savings account for other medical expenses, till the deductible is met.
Health Savings Accounts
- Works along with High deductible plan.
- Monthly deductible which is usually low when go unused can remain in account.
- A tax-free interest is added to the saved money in the account.
Self-Directed Health Plans (SDHP)
Self-directed health plans (SDHP), also known as consumer directed health plans have introduced a new concept for financing health care services. Basically these are usually part of PPO plans.
- Monthly or yearly medical allowances are available to the patients.
- Allowances can be used to get preventive and/or routine medical benefits.
- Allowances are extended to next year, if they remain unused.
A self directed health plan (SDHP) combines the features of a PPO-based plan with the added feature of a Self Directed Account (SDA). The SDA is funded with a maximum quarterly allowance and yearly balance to use for certain types of routine or preventive care services. Unused funds roll over to next year, allowing enrolees to save for health care expenses.
- Prescription plans are usually part of many insurance plans.
- The insurers or health providers form a contract with large pharmacies which sell standard prescription drugs.
- Large pharmacies regulate their supplies and offer discounts to the insurers.
- Discount health plans are usually not part of any insurance policy but based on member benefits.
- As a regular member of an health organization, one may get monthly or yearly discount medical services.
- The discount plans are offers on almost all medical services done at facility along with routine and preventive checkups and care.