and contrast between an HMO plan and a PPO plan. The HMO plan requires participants to have a primary care physician with the network and the participant does not have the option of visiting a physician outside of the network. They must be referred by the primary care physician to see a medical specialist and the specialist must be within the approved network‚ the plan normally costs less than the PPO plans‚ however the co-pay is significantly high. On the other hand‚ the PPO provides its participants
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OBAMACARE Name: The Unknowns Course: Introduction to American Government Institution: Professor Luma Date: 24 March 2015 History Prior to the onset of the Obamacare‚ the American healthcare system was characterized by increasing cost of healthcare. For instance in the 10 years before the implementation of the Obamacare‚ total expenditure increased at a constant rate. These rising rates of expenditure were unearthed to be caused by the new technology and medicines; this is according to the
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Financial Aspects of Health Care Delivery Jentry Pippin HCS/310 April 23‚ 2012 Emilie Smith Health care expenditures in the United States continue to soar with health
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usually choose a PPO plan. A trend that is gaining popularity with employees and employers is the consumer driven health plan (CDHP) that has a high deductable combined with a funding option of some type. All of the plans have unique features for coverage of services and financial responsibility. The PPO plan is the most popular of all of the plans that doctors‚ hospitals and clinics‚ and pharmacies contract with to provide services to the insured patient. The main feature of the PPO is that they
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creating to enhance the growth of cost-effective in the delivery of health care. Managed health care plan is a system that assimilates any management with in accordance of finance that delivers health care services of the covered population. In contrast‚ PPO also known Preferred Provider Organization is the delivery system that commits with medical care providers who gives discounted fees to clients. Nevertheless‚ clients have the opportunity to give health care to participants who are not members but can
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types; Indemnity or Managed Care (Valerius‚ Bayes‚ Newby‚ & Seggern‚ 2008). There are five health plans highlighted in this chapter; Indemnity Plans‚ Health Maintenance Plans (HMO’s)‚ Point of Service Plans (POS)‚ Preferred Provider Organization (PPO)‚ and Consumer Driven Health Plans (CDHP) (Valerius‚ Bayes‚ Newby‚ & Seggern‚ 2008). A short description and comparison is as follows: 1. Indemnity Plans-protection against loss; under this plan‚ the payer indemnifies the policy holder against
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and Healthcare: What are the problems and what can be done? Retrieved September 11‚ 2008 from‚ Senior Living Newsletter Web site: http://seniorliving.about.com/od/manageyourmoney/a/healthcarecosts.htm Understanding the Difference Between HMO‚ PPO‚ and POS.‚ (2004‚ September 16) September 30‚ 2008 from Health Insurance Center Web site: http://www.insurance.com/article.aspx/Understanding_the_Difference_Between_HMO‚_PPO‚_and_POS/artid/70
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Maintenance Organization or better known as HMO. HMOs have their own network of doctors‚ hospitals and other health care providers who have agreed to accept a payment plan at a certain level of services they provide. With HMO‚ you would have to pick a Primary Care Physician within the local approved network where that doctor can coordinate any additional care you might need. If you need a specialist‚ a referral would be needed within the HMO network. HMOs usually have lower monthly premiums‚ but out
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References: Theunissen‚ S. (1999). HMO Health Insurance: Advantages‚ Disadvantages‚ and Options . Pulse Media International‚ ()‚ . Retrieved from: http://www.pulsemed.org/hmo-health-insurance.htm Mahoney‚ M. (2011). Earth Times. Retrieved from http://www.earthtimes.org/articles/press/health-insurance-plans‚1620645.html The McGraw Hill Company‚ . (2004)
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two types of Health Maintenance Organizations‚ you have the Staff Model and Group Model HMOs. With staff model it owns its own facilities and employs physicians‚ group model contracts with private health care providers to provide service to plan members and benefits are payable based on services and charges authorized by an HMO-affiliated doctor or representative. Staff Model vs. Group Model Staff Model HMOs- plan is paid on a “capitation” basis (“per head”)‚ this means they receive a fixed sum
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