Features of Health Plans

Topics: Preferred provider organization, Health insurance, Health maintenance organization Pages: 1 (334 words) Published: July 14, 2011
Features of Health Plans
Erica Watson
HCR/220
June 13, 2011
Linda Johnson

Features of Health Plans

The rising cost of health care is a huge concern in the United States today. Those who have health insurance are extremely lucky because many cannot afford the high cost. I do not have health insurance at the moment nor am I close to being able to afford it, a recent trip to the ER cost me 300 dollars and the doctor examined me and told me she didn’t have the equipment to see what was wrong with me. If I could afford insurance I would definitely go with a PPO plan because it would benefit me and my family better than the others. Having a set copay and knowing I could visit any doctor I choose is well worth the extra money this plan may cost. Similarities between Health Maintenance Organization (HMO) and Preferred provider organization (PPO) 1) They both have large companies that handle claims for family and individual plans that act as a facilitator for provider and patient. 2) Both are offered through places of employment.

3) Both have preferred network providers.
4) Both have yearly evaluations to track the amount of money spent by patients. Differences between PPO and HMO
1) HMO requires you to choose a physician in their network and PPO allows the patient to choose the doctor or hospital. 2) PPO does not require a PCP and HMO does.
3) HMO requires a referral to see a specialist and PPO does not. 4) PPO network is not required to file a claim to receive payment and HMO is. 5) PPO covers out of network physicians visits with a little extra cost and HMO will not cover the visit. Consumer-driven health plan (CDHP) is usually joined with a PPO plan. CDHP has a special savings account for untaxed funds that are put aside for medical bills. This aids the patient in paying out-of-pocket cost and premiums.
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