Health Insurance: Your Questions Answered Coram NY

Health Insurance: Your Questions Answered

What is managed care?

Managed care is a health-care system in which your primary physician acts as the gatekeeper for other specialized medical services. There are three main types of managed care.

• Preferred Provider Organization (PPO): The main concept behind a PPO is the network. If you opt for this type of insurance, you may choose any health care provider from within your network, determined by your policy, or any non-network health care provider. You are usually required to make a co-payment or pay co-insurance. Staying in-network saves you a bundle with the PPO!
• Health Maintenance Organization (HMO): Like the PPO, the HMO requires you to make a co-payment to an in-network physician. However, an HMO will not pay for services you receive outside the network. Your primary care physician acts as the gatekeeper to your health care. In order to obtain specialty care, you must attain a referral from them.
• Point of Service (POS or Open Access HMO): This health insurance plan is similar to the HMO. However, you can go out of network. But the plan usually only reimburses you 50 to 80 percent, and you may be required to pay co-insurance and a deductible.

Is a managed care the only type of health-care system? ...

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