Types of Health Plans
There are three types of Health Plans :
Commercial Health Plans
Also known as private health plan, commercial health plan is any type of health plan that is not offered and managed by a government entity. Commercial health plan companies are for-profit corporations, and offer their insurance services through group insurance plans as well as individual or personal plans. In all situations, a commercial insurance of this type is available only to those who are willing to pay premiums in exchange for the coverage.
Many people have access to commercial health plan through an employer. Sometimes referred to as group insurance, employees who meet the employer’s criteria in terms of hours worked, time with the company, and other factors may be enrolled into the program. Depending on the way that the insurance program is arranged, the employer may absorb the total cost of the monthly premium for each employee, or pay a percentage of the total premium. When that is the case, the employee pays for the remainder of the premium due via a payroll deduction that is withheld by the employer.
While there are a number of different formats for commercial health insurance, three models are the most common around the world.
1. service plan.
This type of insurance coverage allows the client to choose a primary care physician from the list provided by the insurance carrier. Using healthcare professionals that are considered to be in-network ensures that the provider covers a larger share of any medical expenses that qualify under the terms of the contract. Should the client choose to utilize a physician outside the provider’s network, the benefits paid per medical incident are usually decreased.
2. health maintenance organization, or HMO.
As with the point of service approach, participants in an HMO choose a primary care physician from a listing supplied by the provider. In order to see a specialist, the primary care physician must officially refer the patient to that specialist. This type of plan rarely covers medical care provided by healthcare professionals outside the network, except under unusual circumstances.
3.Fee-for-service, or Indemnity model.
This type of program covers a specific listing of healthcare procedures. Clients can see any physician or specialist they wish, without any decrease in benefits. Plans of this type may be very limited in scope, such as focusing on office visits and procedures that are done in the physician’s office. Other indemnity plans are more comprehensive, and include coverage for hospital care related to conditions listed in the provisions of the contract.
When evaluating any type of commercial health insurance, it is important to make sure the plan will provide adequate coverage. This means reading the terms carefully as they related to routine checkups, outpatient procedures, hospital stays, mental health treatments, and the amounts of all applicable deductibles and co-payments. In addition, many people will want to include long-term care insurance in the coverage, as this can help alleviate financial hardship during an extended illness.
Medicare Health Plans
A Medicare health plan is a federally funded health insurance policy available to United States residents. To receive Medicare, individuals must be 65 years of age or older, disabled and on Social Securityrenal disease, which requires dialysiskidney transplant. benefits, or have a form of kidney disease known as end-stage or a
Additionally, to obtain a Medicare policy, individuals must have worked for at least ten years. These years of work do not be consecutive. The Medicare program is open to all individuals who meet these requirements, regardless of income.
Developed in 1965, the Medicare program consists of four types of policies.
1. Part A, is hospital insurance and provides coverage for hospitalization. The Part A policy covers all hospital expenses such as food, tests, doctor’s fees, and in-patient hospital stays. Private rooms, however, are not covered under the Part A Medicare policy unless deemed medically necessary.
2. Part B Medicare provides standard medical insurance to eligible recipients, covering expenses such as doctor’s appointments, outpatient surgery, diagnostic tests, and medical equipment. Other than an initial exam, the Part B policy does not cover routine checkups or yearly physicals. To receive these benefits, recipients must meet a yearly deductible and also pay a monthly premium.
3. Part C, Advantage plan allows users to customize their Medicare policy based on their needs. Similar to private health insurance, the Advantage plan allows users to choose either a Health Maintenance Organization (HMO) plan or a Preferred Provider Organization (PPO) plan. Whereas an HMO plan requires users to select a doctor who works within the plan’s network of physicians, the PPO plan allows them to select a doctor outside the network, if they agree to pay more for those services.
4. The prescription drug plan, or Part D Medicare, helps recipients pay for their prescribed medications. The policy is administered by private insurance companies who meet certain criteria set forth by the U.S. government. Like private insurance plans, prices vary from company to company, so users must compare plans and prices to find the one that is right for their budget.
To enroll in any of the four Medicare policies, individuals must submit an application through their local Social Security office. Applicants should also apply during the open enrollment period, which begins three months before the applicant turns 65, and ends four months after his or her birthday. Individuals currently receiving Social Security benefits are not required to apply for a Medicare policy, however, since they are automatically enrolled in parts A and B when they reach the age of 65.
Medicaid Health Plans
Ensuring that the poor receive quality health care has long been a priority in the United States. Medicaid is one program designed by the federal government to meet this need. Medicaid provides medical care to the poor, to children and to pregnant women living under the federal poverty level. It is funded jointly by the states and the federal government.
Medicaid was established in 1965, at the same time as Medicare, under Title XIX of the Social Securityprenatal care, emergency room visits, drugs and other treatments. Act. It was designed to assist low-income families in providing health care for themselves and their children. It also covers certain individuals who fall below the federal poverty level. It covers hospital and doctor's visits,
Other people who are eligible for Medicaid include low-income children under age 6, low-income pregnant women, Supplemental Security Income recipients, adopted or foster children, specially protected groups, children under age 19 whose family income is below federal poverty level, some Medicare beneficiaries and other groups, as determined by each state. Most families who receive welfare probably have a social worker assigned to them, and this person will usually advise a family on its Medicaid eligibility. Many doctors will also be able to inform their patients about Medicaid.
While perhaps not as Byzantine in construction as Medicare, determining Medicaid eligibility, in particular, is still tricky. Anyone feeling he or she may be eligible for Medicaid can contact the local department of human resources or the Internet for more information. The official official website includes a wealth of information, as well as a toll-free number. As is the case when dealing with most federal programs, people are well-advised to seek out professional assistance and get as much information as possible about the program in order to receive the maximum benefit.
Source : http://www.wisegeek.com/