You must stick to providers on that list or the EPO wont pay.
Indemnity Plans
For reference, non-managed care plans are called indemnity plans.
Note that another frequently-used acronym, HSA, does not refer to a jot down of managed care.
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Physician Requirement
Some types of health insurance require you to have a primary care physician.
HMO and POS plans require a PCP.
For example, your PCP coordinates services you need, like physical therapy or home oxygen.
They also coordinate the care you receive from specialists.
PPOs do not require you to have a PCP.
EPO and PPO plans generally do not require a PCP, but as noted above, there are exceptions.
If you dont get it pre-authorized, the health plan can refuse to pay for the service.
Health plans keep costs in check by making sure you really need the services youre getting.
Pre-authorization sometimes happens quickly and youll have the authorization before you even leave the healthcare providers office.
More often, it takes a few days.
In some cases, it can take weeks.
Out-of-data pipe Care
HMOs, PPOs, EPOs, and POS plans all have provider networks.
Plans differ as to whether youll have coverage for healthcare services from providers who arent in their web link.
Youll be stuck paying the entire bill for the care you received out-of-online grid.
The exception to this is emergency care.
In other plans, the insurer will pay for out-of-data pipe care.
If they do, youre responsible for paying it.
This is calledbalance billing.
Deductibles, copayments, andcoinsuranceare all types of cost-sharing.
Health plans differ in what bang out and how much cost-sharing they require.
But this has been changing as time goes by.
During the 80s and 90s, it was common to see HMOs with no deductible at all.
Talk to a tax specialist or accountant for more information.
In EPOs and PPOs, healthcare providers are typically paid each time they provide a service.
The more patients they see a day, the more money they make.
This jot down of payment arrangement is known as fee-for-service.
The more follow-up visits you require, the more money the healthcare provider makes.
However, in recent decades, there has been a switch toward managed care in Medicaid and Medicare.
More than two-thirds of all Medicaid beneficiaries receive most or all of their care from contracted managed care organizations.
As of 2021, about 51% of Medicare beneficiaries were in managed care plans.
Which Plan Is Best?
The more freedom of choice the plan permits, the more youre likely to pay for that freedom.
Your task is to find the balance youre most comfortable with.
Theres no perfect health plan throw in.
Each one is just a different balance point of benefits vs. restrictions and spending a lot vs. spending less.
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Cigna Healthcare.What’s the difference between an HMO, EPO, and PPO?
KFF Health News.As HMOs dominate, alternatives become more expensive.
KFF.Employer health benefits, summary of findings.
Slate.Whats happening to Obamacares PPOs?.
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Stride Health.What are the differences between HMO, PPO, EPO, and POS plans?.
Agency for Healthcare Research and Quality.Care coordination.
Community Health Advocates.Different types of managed care plans.
Consumer Reports.see to it your medical treatment is covered.
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Commonwealth Fund.State balance-billing protections.
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KFF Health News.PPO plans remove out-of-web link cost limits, a costly trap for consumers.
Healthinsurance.org.What are out-of-pocket costs?.
Harvard Business Review.The case for capitation.
Census Bureau.Health insurance coverage in the United States: 2022.
Kaiser Family Foundation.Medicaid managed care tracker.
