Unformatted text preview: Health Insurance Options in the United States the Jerry Byrd July 23rd. 2010 What is Health Insurance? What Insurance is purchased to protect from Insurance financial losses in the future. financial Health insurance is purchased to protect Health from financial losses due to expenses that occur from medical services. that Can be purchased via the private sector Can or publicly funded. or 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, http://www.law.umaryland.edu/marshall/crsreports/crsdoc http://www.law.umaryland.edu/marshall/crsreports/crsdoc uments/RL3223702032005.pdf http://www.agencyinfo.net/iv/medical/types/hmo-ppo-pos.h http://www.agencyinfo.net/iv/medical/types/hmo-ppo-pos.h Military.com. Understanding TRICARE. Military.com. ...
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- Spring '10
- preferred provider organization, health insurance options