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Unformatted text preview: Health Insurance Options in the United States States
Jennifer Hill October 2,2010 What is Health Insurance? What Insurance is purchased to guard from Insurance financial losses in the future. financial Health insurance is purchased to shield Health from financial losses due to expenses that occur from medical services. occur Can be purchased via the private sector or Can publicly funded. publicly Can be purchased by individuals or Can through employers or associations. through Beginnings of Health Insurance Insurance Franklin Health Assurance Company of Franklin Massachusetts – 1850 Massachusetts Accident insurance – 1860 Sickness coverage – 1911 Predecessor to HMO – 1929 Modern Health Insurance Health Insurance Options Health Managed Care HMO – Health Maintenance Organizations PPO – Preferred Provider Organization POS – Point of Service TRICARE Managed Care Managed Emphasis on preventative care Service delivery and financing functions Service are integrated are Control cost and health care use Benefits: Lower cost Disadvantages: Provider and service Disadvantages: restrictions restrictions HMO HMO
Low costs As costs increased, restrictions lessened “In-network providers”, “gate-keeping”, “case In-network management”, and “pre-certification” management”, Benefits: Co-payment cost share, focus on Benefits: preventative care, no maximum lifetime payout preventative Disadvantages: out of network providers are Disadvantages: not covered, tighter controls make it difficult to get specialized care get PPO PPO Preferred Provider Organization Deductible and co-insurance Benefits: ability to choose providers Benefits: outside of the network, out of pocket expenses limited expenses Disadvantages: “out of network” means Disadvantages: higher costs, more paperwork higher POS POS
Point of Service HMO/PPO Hybrid Benefits: More options, fewer expenses, Benefits: no deductible, no gate-keeper, out of pocket expenses limited pocket Disadvantages: more costs as the Disadvantages: consumer moves away from the managed aspects, more restrictions on specialized care specialized TRICARE TRICARE Managed care for military personnel and Managed their dependents their Options such as TRICARE Standard, Options Prime, Extra, and Reserve Select Prime, Options similar to HMO, PPO, or POS Options plans plans Benefits and disadvantages similar to Benefits other managed care other References References Fernandez, B. 2005. Health Insurance – A primer. CRS Fernandez, Report for Congress. Retrieved September 25,2010 from from http://www.law.umaryland.edu/marshall/crsreports/crsdocu ments/RL3223702032005.pdf Health Insurance, 2010. Retrieved September 25,2010 Health from http://www.agencyinfo.net/iv/medical/types/hmo-ppo-pos.h http://www.agencyinfo.net/iv/medical/types/hmo-ppo-pos.h Military.com, 2010. Understanding TRICARE. Retrieved September 25,2010 from September http://www.military.com/benefits/tricare http://www.military.com/benefits/tricare ...
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This note was uploaded on 10/10/2010 for the course 225 BEH taught by Professor Griffin during the Spring '10 term at University of Phoenix.
- Spring '10