Managed care models

Managed care models

Managed care models allude to the forms of health insurance. The various models contain agreements. These contracts are consequently made with healthcare providers, alongside the relevant care institutions, for holders, at a reduced price (“MedlinePlus,” 2020). As such, the providers make up the plan’s network, and the amount to be paid depends on the network’s rules. Thus, examples of some of the managed models entail Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO).

In regards to the HMO, the model only contributes towards the pay for care within a specific network. Here, an individual is only predisposed to select a primary care doctor who will, in turn, manage most of the care (Shinkman, 2020). On the other, PPO normally contributes more if one gets care within the set network. Interestingly though, they also pay part of the total costs if one goes outside the network.

Concerning the differences, unlike HMO, PPO harbors the ability to see a health provider one needs without requiring a PCP to authorize any treatment form. Also, PPO allows any referral from a PCP not required to see a health care provider, while HMO does not (Shinkman, 2020). Finally, HMO is characterized by low or none deductibles and generally reduced premiums when compared to PPO.

About similarities, both the care models allow access to a network of doctors, health facilities, and other necessary healthcare providers. Also, they are co-pays alongside other premiums. In this case, co-pays apply to deductibles, paid annually to cater to health care costs (Dalton, 2020). Seemingly, it is important to highlight that despite both being subject to co-pays, HMO tends to be slightly lower than PPO, although they can run to thousands of dollars, in situations of serious ailments.