Understanding Managed Health Care Insurance Plan Options

So you’re out there looking for affordable personal health insurance quotes. Well, these days affordable health insurance pretty much means managed care health insurance, which also means somebody other than you is in control. By definition, a managed care plans are a system that controls the financing and delivery of medical and other health care services to its enrolled members, who in turn realize a cost savings. Start shopping for managed care plans online and you may feel like you’re drowning in a big bowl of insurance alphabet soup. Basically you have three types to choose from:

  • HMO – Short for Health Maintenance Organization, an HMO creates a provider network of doctors, hospitals and other health care professionals who contractually agree to provide services to HMO members at a discount rate. Think of it as a volume operation. The provider network is assured of lots of referrals, while you as a member get relatively cheap health care insurance. You choose a Primary Care Physician (PCP) from the network. Unless it’s an emergency situation (be sure to read the fine print about what constitutes an emergency), this is the doc you see first for treatment or authorized referral to a specialist. The health insurance quote you receive for an HMO will typically be the least expensive health care insurance in terms of your out-of-pocket costs, but it’s also the most limiting in terms of your choices.
  • PPO – This stands for Preferred Provider Organization. There’s still a contracted provider network, but you don’t need a Primary Care Physician acting as a gatekeeper before you can see a specialist. While you’re allowed to use providers outside the network, the PPO will reward you for staying in the network. Incentives often include lower co-pays and bigger reimbursements. You pay a price for choice; your health insurance quote for a PPO will probably run higher than an HMO and include more out-of-pocket costs.
  • PSO – A Point of Service (PSO) plan is kind of a hybrid between an HMO and a PPO. It’s a little more flexible than an HMO. For instance, you don’t have to choose a Primary Care Physician, but you’ll pay a higher co-ay or deductible than other PSO members who do use one. You can also opt to use out-of-network providers, but again, your co-pay and deductibles will be greater.

When comparing health insurance quotes from managed care plans, be sure that the quality of care doesn’t take a back seat to the control of costs.


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