United State’s Insurance Options Name HCA 210 June 26,2011 Professor’s name United States’ Insurance Options presentation.

The History of Health Insurance First modern group plan was formed in 1929 (Northern California Neurosurgery Medical Group,2007) Blue Cross Blue Shield offered group health plans in 1932 (Northern California Neurosurgery Medical Group,2007) In 1929 the first modern group health insurance plan was created. A group of teachers in Dallas, Texas contracted with the Baylor Hospital for room, board, and medical services in exchange for a monthly fee (Northern California Neurosurgery Medical group,2009). A nonprofit organization called Blue Cross Blue Shield in 1932 was the first to put forward group health plans. The Blue cross Blue Shield Plans were thriving because they involved discounted contracts with the doctors and hospitals. In return the providers gave discounts to the Blue Cross and Shield plans (Northern California Neurosurgery Medical group,2009).

The Purpose of Health Insurance Helps people pay for medical care services. Makes health care services more reasonably priced for patients. Helps pay for all medical services. The purpose of health insurance is to help patients pay for medical care services. Health insurance gives patients the chance to obtain treatment for their medical issues.

Insurance Options HMOS Managed care PPO POS TRICARE Health insurance is offered through one’s employer and then the employee has no options, he or she takes what is offered to them. Self paying is different because one has many options to choosing from. The most common health insurance plans are HMOs, Managed care, PPO, POS, and TRICARE which is for Uniformed Service members, retirees and their families.

HMOs Advantages Medical Records Level of Care Level of Benefits HMO (Health Maintenance Organization) is a plan that is directed by a health maintenance organization. One needs to choose a primary care physician for his medical needs. Referrals are needed to see specialists and to have diagnostic tests done. HMO networks have high standards of which providers are allowed in to the network, and are well known for quality control in providing medical services (HMO vs PPO,n.d.).

HMOS Disadvantages Limited Geographical Accessibility Must Choose Primary Care provider Difficult to Get Second Opinion The disadvantages for HMOs plans are that one cannot go to any doctor, or hospital. HMOs networks are usually in highly populated areas. HMOs do not exist in rural areas. Difficult to switch your doctor and to get a second opinion (HMO vs PPO,n.d.).

Managed Care Advantages Disadvantages Little or none Paper work Lower co-pay for medical services Disadvantages Less time with physician and fewer costly test and treatments Physician and hospital may not be your choice Prior authorization for specialist and medical care services The advantages of Managed care are, that there is there is little or no paper work. Lower co-pay for medical services. Disadvantages of Managed care are that the plan only pays for care provided by their own physicians. Managed care creates pressure to do more with less: the physician should spend less time per patient, less costly medicines, and less costly diagnostic tests and treatments (Washington.edu,2008).

PPO Advantages Disadvantages Providers are available across the U.S. Choice of providers and services. Easier to switch doctors and obtain second opinions. Disadvantages Transferring of medical records Variation for out of pocket cost PPO (Preferred Provider Organization) Providers agree to accept reduced payment for services and in return they are able to have a larger client base to serve. One can have medical services provided by any provider with out referral, and this gives one more options. One can have any provider within or outside of network. Transferring of records between doctors is difficult because they are not kept centrally. The PPO health plan covers office visits, hospital stay, lab work and x-rays (HMO vs PPO,n.d.).

POS Advantages Disadvantages Difficult to obtain referrals Minimum co-pay for in network car Paper work is completed for you. Disadvantages Difficult to obtain referrals Limited compensation for out of network providers One’s primary physician who has to refer him or her to out of network physicians and specialists will try to keep him or her inside the network. POS (point of service ) is based on the managed care foundation for lower medical costs in exchange for limited choice. It has the same characteristics as the HMO and the PPO. A primary physician monitors your health care and he or she must be within the health care network. Paperwork is completed for you at the time of your medical visit. With your co-pay your office visit is covered including the labs and testing (East Coast Health Insurance,2010).

TRICARE Advantages Disadvantages Widely available Choice of providers No Balance billing No forms to file No enrollment fee Disadvantages Not widely available No Primary Manager Limited choice of providers Specialty care by referral only Triple Options Health Care Program for Uniformed Service members, retirees and their families. TRICARE is a regionally managed health care program, which works with networks of civilian health care professionals to provide better access and high quality service while maintaining the capability to support military operations(Military,2011).

References HMO vs. PPO Comparison (n.d.). In HMO vs PPO.org. Retrieved June 26, 2011, from http://hmovsppo.org/ Managed Care. (2008). In Washington.edu. Retrieved June 26, 2011, from http://depts.washington.edu/bioethx/topics/manag.html The History of Health Insurance In The United States . (2009). In Northern California Neurosurgery Medical Group. Retrieved June 26, 2011, from http://www.neurosurgical.com/medical_history_and_ethics/history/history_of_health_insurance.htm The POS's (2010). In East Coast Health Insurance. Retrieved June 26, 2011, from http://echealthinsurance.com/managed-care/pos-health-insurance/ Your TRICARE Benefits Explained (2011). In Military.com. Retrieved June 26, 2011, from http://www.military.com/benefits/tricare/understanding-your-tricare-benefits Photos by (Google images,2011) References