Question

define and describe HMOs, PPOs, and POS plans, describing trends in each since the 1990s. define Managed care.

Answer 1

these are the most common health insurance plans

1.HMO

HEALTH MAINTENANCE ORGANISATION

its known for its lower premiums and restricted network of doctors and hospitals, which means you sacrifice flexibility for lower upfront costs.

pros: lower premiums, lower cost than PPO

cons: need to stay in network, need referral to see a specialist

when an HMO might be right for you ?

. you have a primary care physician and other providers who are in the HMO network

. you dont see any specialist and dont need referral often

. you dont mind the limitations of only seeing providers in your network

. cost is more important to you than flexibility

PPO

PREFERRED PROVIDER ORGANISATIONS

pros: larger networks, can go out of network, dont need referral

cons: higher premium, deducible

when a PPO might be right for you ?

. need flexibility to go out of network

. not need to get referral

. who utilizes health care regularly

POS

POINT OF SERVICE PLAN

pros: dont need referral, can go out of referral

cons: need to file claims if you go out of network, higher deductibles than PO and HMO

when POS might be right for you ?

. when you have PCP in POS

. when you are good at keeping receipts

managed care is described as the group of activities intended to reduce the cost of providing for profit health care and providing American health insurance while improving the quality of that care