HMO

Everybody needs affordable health care coverage. There are many different HMO's and PPO's to choose from, so it is important to know the facts before you settle on a company.


1. What Is An HMO?

An HMO is a Health Maintenance Organization. Specifically, it is a type of health insurance that is used by those living in the United States. It is not quite like traditional health care coverage. An HMO is allowed to set their own guidelines under which doctors can operate. An HMO usually costs less than having regular health insurance, but may have limitations to what kinds of treatments are available. They may have more of a say in your health care services than one may desire, yet they are usually much more affordable.

In the early 20th century, many businesses started to offer their employees medical programs that were prepaid. Those people were taken care of as long as they stayed within the allowed procedures. In the year 1973, the HMO Act was passed, and the HMO became a mainstay in the American medical community.

Cheaper insurance can be received with an HMO, because the HMO can negotiate for more affordable health care than a patient with no health care plan would get. An HMO can eliminate treatments that they deem unnecessary, thus reducing costs and fees. This may or may not be beneficial to the person using the HMO. There are many different HMO's operating in the United States today.

2. Advantages Of An HMO

Being a member of an HMO may have many advantages. First, the cost is usually minimal. Many insurance companies have co-payments, meaning you are responsible for a certain percentage of your medical bill or prescription. Or, there could be an annual deductible that a patient has to meet before the insurance company will start paying for coverage. Many HMO members simply pay one monthly fee, and it does not matter how much medical attention they receive per month.

HMO's don't just cure sickness and disease; they also attempt to prevent it. They encourage their members to seek out medical treatment early. This way, issues may be resolved before they get too severe, thus costing more money. HMO's typically offer well-baby visits, immunizations, mammograms, and physicals. This way, problems may be caught early, preventing the need for more costly medical services later. Also, there are many HMO's that offer other preventative care, such as discounts to gyms, or health education classes to increase your knowledge of better health. Even if the issues are severe, HMO's typically don't have a limit of your lifetime benefits, which is not like most insurance plans. As long as you are a member, your HMO will cover your treatment. An HMO can be a great type of medical insurance for you and your family.

3. Medicare

Medicare is one of the most used insurance programs for senior citizens today. This program is provided by the government, and can give coverage to those ages 65 and older, or those with a disability, no matter what your income is. There are three parts to Medicare: Part A, Part B, and Part D.

Medicare Part A covers care that is received in a hospital as an inpatient, in a nursing home, and also home health care and hospice care. Part B is for medical services that are deemed both necessary and reasonable. These will include visits to the doctor, any x-rays that may be needed, any laboratory or blood work done, ambulance service, outpatient health care, and any home health care that is necessary. It may also include necessities such as a hospital bed needed in the home, or a wheelchair, as well as some medical supplies for use in the home. Medicare Part D is a generally new program that covers prescription drugs. It is currently only available through either private drug plans or private health plans through Medicare.

A person who is eligible for Medicare must be 65 years or older and have been a United States citizen for 5 straight years. You may also be eligible if you are under 65 and disabled, and have been getting disability benefits through social security (also called SSDI) for a minimum of 2 years. You may also receive Medicare if you receive dialysis for permanent kidney failure, or if you are in need of a kidney transplant. Those who have Amyotrophic Lateral Sclerosis can also qualify for Medicare services.

4. Medicare Advantage Plans

There are many advantages for senior citizens to use Medicare after they turn 65. Another plan available is the Medicare Advantage Plan. For instance, most Medicare is available with either little, or even no, monthly premiums. Those who hold the Medicare Advantage plan still are allowed to keep the rights and protections they get from Medicare. There are added benefits that include preventative care services and also eye glasses. The user does not have to worry about paying bills or processing any claims themselves; it is all done for them. There is also no limit to the number of days a person may stay in the hospital.

A member of Medicare Advantage is not exempt from receiving care from regularly covered Medicare services. In fact, plan holders who use Medicare advantage will also be allowed to use additional services that Medicare supplements, or even regular Medicare provides. Another benefit of this plan is that prescription drugs are often included at no cost to the holder. Supplemental Medicare policyholders usually have to pay for the Part D prescription plan. The Medicare Advantage plan has many benefits to using it, and can be very beneficial to seniors who need many prescription drugs. It is worth a look into.

5. Managed Care Plans

Many senior citizens need to understand how managed care plans work. Insurance companies contract with professional health care providers to enable the providing of many different health care services to their patients. Many people receive managed health care insurance from their place of employment. Their management will pay the managed care health insurance company in advance to pay for your health care in the future. They will set a certain amount of money to do this. When you go to receive health care, you will then pay a co-payment.

When you have managed care, you generally have to choose your doctor and your hospital from a list of approved places from your plan. It is possible, on some plans, to pay more to see a doctor that is not on the plan. You may also have to get approval from your plan before you see certain specialists or go to the hospital. When finding a managed health care provider, you must be knowledgeable and understand the differences that different companies offer. Make sure to talk to a licensed insurance agent before settling on a managed care plan. Your health is important, and you should be given understanding, patience, and respect while you are searching for the best option.

6. Types Of Managed Care Plans

When looking for an insurance plan, it is important to understand that there are many different types to choose from. The most common plans are what many people already know of: health maintenance organizations, or HMO's. There are also preferred provider organizations, or PPO's. Health care is a continually changing organization, so it is logical that managed care plans will also change, grow, and evolve. Always knowing what specific rules are, and how they apply to you, is important to receiving the best possible care. An individual may buy their own managed care policy, or you may join through your employer's health programs at work.

There are four important elements you need to know about managed care plans. The first thing to understand is that these types of plans are a business, first and foremost. If you become ill, the plan will do their best to keep costs as low as possible to treat you. The second key thing in managed care plans is to stay up to date with your health by being an active partner and learning about your health care by speaking to your doctors and nurses. Thirdly, be prepared to stand up for yourself. If you are denied treatment that you feel is a necessity, be ready to appeal it. Finally, the best prevention is eating healthy and staying active, having yearly physicals, and maintaining a healthy lifestyle.

7. Preventative Medicine And Practice

The best way to keep medical costs down in the first place is to practice preventative medicine. This should be a big part of health care services. Preventing major illnesses, such as heart disease and strokes, not only save lives, but saves money for the insurance company, as well. Cardiovascular diseases have declined rapidly because of preventative care, as well as many other sicknesses and diseases. The build-up of fatty deposits in the arteries, called atherosclerosis, may begin at childhood, but does not show up for years. There are many risk factors that can be controlled in everyone's lives that can help prevent heart disease and more.

Harm from tobacco smoke is one thing that can be prevented by not smoking. High blood cholesterol can be monitored. High blood pressure can be moderated by physical activity and a sensible diet. Learning to live a healthy, active lifestyle can put years on a person's life, as well as prevent sickness and disease. Focusing on prevention can cause a major adjustment in people's health. It is also beneficial to HMO's and insurance companies, as prevention means less surgery, fewer doctor's visits, and shorter hospital stays. It is important to find an HMO that offers benefits such as preventative medicine. Some may offer health and wellness classes, weight loss classes, smoking cessation classes, and even gym memberships.

8. What Is A Co-payment?

When one starts an insurance plan, or becomes a member of an HMO, there may still be costs associated with their plan. One of these costs is a co-payment. Co-payments, which may also be called a co-pay, is a capped contribution paid by the insuree for a medical procedure. More simply, it is the patient's part of the bill they must pay. Insurance companies may use co-payments to split up the costs of health services. It is thought that a co-pay may help keep costs down for insurance companies, because people won't get medicine or schedule doctor's appointments for common illnesses, such as the flu or cold, if they have to pay a co-pay.

It is also thought, however, that having a co-pay may actually discourage some from seeking medical attention that is needed. Some people simply do not have the funds when they are sick to see a doctor, or the money to make a co-payment on a needed prescription. Those who have a chronic condition may also have trouble paying co-payments, as they are continually in need of medical assistance such as doctor's visits. However, co-payments are part of many insurance companies and HMO's and are a fact of life in the insurance world.

A co-payment is usually a small amount, typically running between $5 and $15 dollars. They are less common in PPO's, and more common in HMO's.

9. Tips For A Healthy Lifestyle

The best medicine is prevention and a healthy lifestyle. The better care you take of your body, the less you will need health care. You may also receive discounts on health insurance if you have no pre-existing conditions. Maintaining a healthy and active lifestyle will not only extend your life span, but also help your insurance or health maintenance organization.

There are many tips for maintaining a healthy lifestyle. Staying at a healthy weight is important for many reasons, such as high blood pressure, cholesterol, and the risks associated with obesity. These risks may include diabetes. Eating fresh fruits and vegetables, and less processed food, can keep your body healthy. Smoking and alcohol consumption should all be done in moderation, and of course, no illegal drugs should be put into one's body. Exercise should be performed daily, or at the least, two to three times a week. Regular doctor and dentist visits should be performed, as well as vision appointments. Taking care of your body today will keep you healthy, and save money for both yourself and your insurance company or HMO. Insurance companies like to take on healthy patients, as they will save them money in the long run.
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