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Health care in America is changing rapidly. Twenty five years ago, most people in the United States had indemnity insurance coverage. A person with indemnity insurance could go to any doctor, hospital, or other provider (which would bill for each service given), and the insurance and the patient would each pay part of the bill.

But today, more than half of all Americans who have health insurance are enrolled in some kind of managed care plan, an organized way of both providing services and paying for them.
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Different types of managed care plans work differently and include preferred provider organizations (PPOs), health maintenance organizations (HMOs), and point-of-service (POS) plans.

Types of Health Insurance Plans



In the United States, there are two broad categories of health plans - plans from private companies and government-sponsored plans. Most working adults obtain their healthcare coverage from privately-owned insurance companies or managed care plans. Governmental (public) programs are available to support the healthcare needs of children and adults with limited income, the retired and those who have been injured on the job or otherwise disabled.

Private Insurance
Private insurance can generally be categorized into two types of plans -major medical (also known as fee-for-service or indemnity) and managed care. There are three basic types of managed care plans: health maintenance organizations (HMOs), preferred provider organizations (PPOs) and point-of-service (POS) plans. To learn more, click Managed Care and Major Medical on the left navigation menu. If you're not sure which type of plan is best for you, use our Plan Type Evaluator. Answering a few questions about your personal preferences will generate a suggested plan type that is best for you.

Specialized Plans
While there are two major types of private health insurance, plans are also available for special needs or for select groups of individuals. Such plans include short–term medical coverage, student plans, catastrophic care coverage, disability policies and policies that supplement Medicare (Medigap). See Other Types

Public Insurance
A variety of governmental programs are available to assist the retired and those in financial need. They include Medicare, Medicaid, Workers' Compensation, Disability and new children's healthcare initiatives


Difference between Traditional, PPO and HMO coverage



Traditional: There are no lists of physicians and hospitals. You may use any Doctor you want to, and the plan will pay the bill (subject to UCR clauses). Some plans consider a physician as a "licensed practitioner of the healing arts, which practices within the scope of their license". This lets you use Naturopathic and Chiropractic practitioners.

PPO: A Preferred Provider Organization is a network of physicians and hospitals that have agreed, by contract, to discount their rates to members. The networks are typically very large, and the members are free to seek care from any physician or provider within the network, including specialists without a referral. Members may also access non-contracted providers, but at a higher out-of-pocket cost. If you were to buy a PPO plan instead of a Traditional plan, you would never know the difference as long as you used the provider list. Typically PPO plans might offer some front-end co-payments for such services as doctor visits and prescriptions. Most other covered services (i.e., inpatient hospital services and surgeries) are typically subject to a calendar year deductible and/or coinsurance (where applicable).

HMO: A Health Maintenance Organization provides benefits for preventive care coverage and low out-of-pocket costs. There is typically no coverage for care from doctors or hospitals outside your HMO. Plans usually offer comprehensive benefits and affordable premiums with no deductibles. You choose a Primary Care Physician from a network; This Doctor oversees all your care, and may provide referrals to specialist if needed.


Compare plan details from many medical insurance companies like Aetna, Assurant, Celtic, Golden Rule, Health Net, Humana, Nationwide, PacifiCare, Unicare, United Health Care and Blue Cross and Blue Shield of various states.
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Helpful Hints

Live a healthy lifestyle.

Switch to an HMO. Premiums and out-of-pocket expenses tend to be lower for HMOs than they are for other arrangements, but you'll have less flexibility: Your primary care doctor will decide if you need a specialist and you'll have to pick one from an approved list. Read the coverage limits carefully, you may have to pay more for some kinds of coverage, such as mental health claims.

Make the most of your employer's flexible spending account. If your employer offers one, you can pay for unreimbursed medical expenses with pretax money.

Don't Smoke - Smokers can expect to pay twice the premium as non-smokers! Even if you occasionally smoke a cigar, be forewarned that you will not qualify for non-smoker rates.


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