Today, most Americans that have medical insurance are enrolled in a managed care plan of one sort or another. Managed care plans have, for some time now, been the general trend that medical insurance has gone in. Choosing the right medical insurance means knowing a little bit about managed care plans and what they can do for you.

The Dreaded HMO

If you’ve listened at all to people complaining about their insurance company, they’re probably complaining about an HMO. To hear some folks tell it, HMOs are the spawn of hell itself, and the root cause of the health care crisis in the United States. Still, there’s a lot of misinformation out there regarding HMOs.

An HMO is a Health Maintenance Organization. In an HMO, you will receive the bulk of your medical care from a specific provider – one who is a part of a care network. An HMO requires you to select a PCP – a Primary Care Physician. That PCP manages and coordinates all of your health care needs. Your PCP is your personal doctor, and is the one that must make recommendations to your medical insurance company if she believes you need to see a specialist.

PPOs – A Step Up

A PPO medical insurance plan is one that has a network of health care providers that fall into a “preferred” category. You don’t have to have a PCP the way you do with an HMO, and you don’t need to have a referral in order to see a specialist.

In a PPO medical insurance plan, you’re responsible for your co-payment during visits to doctors that are “in network.” Doctors that are not members of the network are still covered, but you have a higher co-pay amount and usually need to pay the doctor directly and then follow up with a claim to your insurance company to get reimbursed.

Looking Ahead

As medical costs increase, more and more employers are switching to HMO-style medical insurance plans. In spite of the bad press that HMOs often receive, there are significant advantages and cost savings involved in that type of plan. The danger, of course, is when the medical insurance company wants to interfere with the decisions of the PPO and, for example, refuse to pay for a referral to a specialist or for a specific sort of procedure that the health care provider believes is necessary to the patient’s health.

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