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Medical Plan Comparison Essay

1082 words - 4 pages

Whether an employee receives health insurance through his/her employer or purchases it on their own, they may have an opportunity to choose between several options. Understanding the different types of health plans is the first step in making a good choice for them and their families. The three medical plans are HMO, PPO, and POS. The cost for both employer and employees, the flexibility of the plan choices and benefits, and the accessibility, limitation to the participants will be analyzed.Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO) are two of the most popular medical plans provided by employers and chosen by employees. These two plans are basically the same except for certain changes for the employer and employee. An HMO plan provides employers a way to take care of their employees' healthcare needs with reduced cost by negotiating with specific doctors, hospitals, and clinics. These specific providers must be used by the employee for the reduced fees to be provided to his or her medical insurance plan. In a PPO plan, the employer can also provide healthcare to the employee at reduced costs. However, the employee has the option of seeing a medical provider in the network or out of the network. A provider in the network, similar to the HMO, is one who has been previously negotiated with by the employer. If an employee with a PPO plan decided to go out of the network, the employee would then pay a higher out of pocket cost.A type of managed care healthcare plan is Point of Service (POS. POS employees can choose their own Primary care physician (PCP) , these physicians agree to provide services to them at discounted costs to their health insurance plan. The employee can choose between an in-network and out- of- network provider. POS plans are similar to Health Maintenance Organization HMO plans. Health plans let employees choose his or her primary care physician and Preferred Provider Organization (PPO) plan and they let employee go out-of-network. POS plans are like a hybrid between the two. However, POS's may require employee pay a deductable and pay for a portion of the insurance and will only reimburse employee from 50% to 80%. The benefits in this type of insurance plan are:•If you can't pick a primary care physician, however, when you have a medical issue you must have a chosen physician as the main contact before moving on to a specialist•You like the flexibility of choosing a out-of-network PCP and don't mind the higher costs•You can't choose between a HMO or a PPO, then a POS plan is for you•You can self-refer to a provider out-of-network and you don't have to wait for approval before getting medical treatment•With POS you have a higher freedom however, at a slightly higher costThe POS plans are more flexible. They save you money when you get medical care in-network.Employees who have these medical plans can elect to have his or her spouse or dependents covered. HMO's, PPO's,...

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