Managed Care Health Insurance Plans
A managed care health plan works as a network. It is a group of medical personnel and facilities that have a contract with this particular plan. They all work together to offer medical services to those that are members. For the most part, this plan has requirements that members use the medical personnel and facilities within the plan’s network. In a nutshell, using this plan is limited as far as providers, but benefits you on the cost. Health care insurance in Texas uses this overall plan.
The appeal of managed health care plans lies in the fact that they have lower premiums than other types of health insurance in Texas. This is largely due to the rates and fees charged for medical services agreed upon by the doctors and hospitals. They are chosen because they are willing to reduce their rates to work with the insurer. Expensive diagnostic testing and certain medical procedures are kept to a minimum or avoided entirely. In addition, managed care health plans offer wellness programs such as smoking cessation, so patients will stay healthier and require fewer visits to doctors and hospitals.
Managed care providers offer three different categories of health insurance in Texas:
HMO (Health Maintenance Organization) - With this plan, you can use doctors and other medical services that are within this network. It works the same way with health care insurance in Texas. An HMO has a primary care physician that you can select from the network. Members pay a set fee each time they visit the doctor.
PPO (Preferred Provider Organization) - This plan allows you to see any doctor you choose. The only disadvantage with this is that if the doctor is outside of the network, you will have to pay more. With health care insurance in Texas, it is strongly encouraged that people use a doctor within the network.
POS (Point Of Service) - This optional plan allows you to use doctors and other medical services outside of the HMO network. Also, you are not required to get a referral. Doctors and other providers used outside of the network will require you to pay more, even for health care insurance in Texas.
For health care insurance in Texas, you are required to pay a premium in order to keep the health plan active. For certain medical services, such as surgeries, you may be required to pay a deductible before the insurance will pay anything. The deductible is an out-of-pocket expense that you provide. Depending on what insurance plan you choose, you will pay that certain deductible amount before your insurance kicks in.
Also, most health insurance plans in Texas will require you to pay a co-pay every time you visit the doctor or get a prescription filled even after your deductible has been met. Some managed care plans have a yearly limit to your out-of-pocket costs and will cover 100% of any charges for medical services or medications that are incurred above and beyond this limit.
If you have health care insurance in Texas, it is important that you go over these plans and determine which one would benefit you the most. It’s even more crucial if you have a family because you have to also look out for them.