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.
Usually, managed health care plans are less expensive than other health care plans. When it comes to health care insurance in Texas, managed care plans extend lower rates because they have handpicked the providers that have agreed to their predetermined rates and fees. The providers also agree to avoid unnecessary tests and procedures in order to help keep costs down. Managed care health plans also provide benefits that encourage members to stay healthy, like help to quit smoking, in order to avoid more expensive health problems later in life.
There are three basic types of plans when it comes to managed health insurance in Texas:
• HMO (Health Maintenance Organization) – An HMO requires you to use the doctors and hospitals in their network. This is fairly standard with most health insurance in Texas. An HMO requires members to choose a primary care physician from their network of providers. The PCP must approve all procedures and visits to specialists. Patients pay a deductable for every office visit.
• 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) – A POS is an optional plan that will allow you to utilize providers that are not in your HMO network. This means you don't have to get a referral. Unfortunately, once again using out-of-network providers will cause you to incur a higher fee as with the other health insurance options in Texas.
Most health insurance options in Texas will require you to pay some type of premium, even with employer sponsored plans. Sometimes you will have to pay your entire deductible before the insurance will cover a single dime even for surgery or emergency room visits. Your deductible the amount you have to pay before your benefits kick in. This is one of the factors you want to consider when choosing a health care plan.
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. Since there are so many variables involved with health insurance plans, it is important to consider your choices wisely before making a decision that can have a dramatic effect on your physical and financial health over the years.
