Managed care health plans work as a network or group of medical professionals and hospitals that are contracted with the health plan. This helps insurance companies and health care providers work together to give patients the care they need. Usually, a managed care plan requires that its members only obtain services through doctors and hospitals that are in their network. Basically, you are more limited in choosing your health care providers, but the advantage is that you save money. Most health insurance providers in Texas use managed care plans.
A managed health care plan is usually cheaper than fee-for service plan. For health care insurance in Texas, their reasoning for charging lower rates is because their hand picked medical personnel and facilities. They allow low rates for these kinds of plans. This plan also focuses on taking care of yourself so that you can avoid getting sick unnecessarily.
The managed care health system uses three types of plans:
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) - A PPO allows for slightly more options because you can go to any doctor you choose. The downside of that is that you will pay more for doctors that are out of the network. As with most health insurance options in Texas, you are better off sticking with providers in the PPO network.
POS (Point Of Service) - POS plans are great for anyone who’s been with a doctor and does not want to change when there is a change in insurance as they tend to have sizable networks. And, like the PPO, patients can see any doctor they’d like without a referral but there is still a network of doctors. Patients choosing to leave the network will find their medical bills much higher than with other health insurance in Texas. A POS plan also the most expensive type of plan because there are fewer barriers for the patient before he/she can receive care.
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.
Each time that you have to see a doctor, you will have to make a co-payment. You will also have to make a co-payment each time you get a prescription filled. There is a certain amount in out-of-pocket expenses that you are required to pay in regard to co-payments. After you have reached the limit and if you reach it within that calendar year, the insurance will kick in and pay 100% of your services. After you have paid your deductible, you will have to pay co-insurance. This is in regard to PPO and POS plans that have network and out-of-network services.
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.
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