The paper “Health Insurance in the US - Methods for Categorizing, Managed Care Plans, the Impact of Managed Care on Medicare and Medicaid Programs" is a delightful example of an assignment on health sciences & medicine. There are different types of health insurance available in the US but there are only three that are common, they include; indemnity plans managed care and health savings accounts. Indemnity plans are commonly known as fee-for-service plans (Niles 2010). This is because the patient under this scheme pays for the medical services (usually in advance) and they are able to see any doctor they wish as they have paid for the service.
Managed-care plans are different from the indemnity plans because it limits the patient or insurer to specific service and not unlimited like the indemnity. As a result of these restrictions, the individuals pay less. There are three types of medical care plans; Health Maintenance Organization (HMO), Point of Service Plans (POS) and Preferred Provider Organization (PPO).
The health savings accounts, on the other hand, provide patients under this plan an ability to save their money in order to afford future medical expenses they may incur. These savings are usually tax-free in order for people to afford it. This insurance policy is suitable for individuals in the lower social class and provides them an opportunity to enjoy the medical benefits from the government.
Describe the three methods for categorizing health insurance in the U.S.
The first method of categorizing is based on the illness of the individual. These include disability benefits, insurance of long term illnesses and even for the aged. The second category is based on the organization sponsoring the insurance coverage. The prestigious organizations have many areas to cover and hence are more expensive.
The selection of the insurance firm will, therefore, depend on the social class of an individual. The third categorization is dependent on the funding mechanism. This is the funding to the insurance organization by other organizations or government. The most funded insurance firms charge fewer costs to their clients hence most people prefer them (Ulmer et al 2010).
Identify the three types of managed care plans and provide the pros and cons of each for the health care provider, insurer, and patient.
The first type of managed care plans is the Health Maintenance Organization (HMO). The advantage is that the patient gets to choose the physician to treat him or her (primary care physician). This way, the doctor knows the patient and all their problems hence can treat them better than if it was a new patient whose medical history he or she is not familiar with. The plan is advantageous also to the insurer as the costs of the premiums are shared among all the members. The disadvantage of this plan is that in case, of an emergency, the patient may suffer because they have a primary care physician who examines them and not any other, this is deemed as a waste of time and risky to the patient’s health (Kongstvedt 2007).
The other type of managed care plan is the Preferred Provider Organization (PPO). They are advantageous to the patient in that they pay less for the health services due to the cost-sharing with the hospitals and health care providers. This also proves to be an advantage to the insurer as they will incur less cost. It is similar to the HMO in that the doctor treats their patient whom they get to know well. However, this plan attracts more patients due to the low prices and hence becomes unmanageable to the doctors as they are overworked.
The third managed care plan is the Point of Service Plan (POS). The advantage of this plan is that the patients can choose even doctors and physicians from other networks other than the ones provided in the scheme. This proves to be an advantage to the doctors too as the burden of having to attend to many patients is reduced. The insurer also benefits by having many individuals chose this plan due to its flexibility. The disadvantage is that an individual requiring the out-of-network services has to reach a certain amount of deductibles first which is around $300 per year per individual.
Describe the impact of managed care on both the Medicare and Medicaid programs.
Medicare and Medicaid programs are those health care programs designed for aged individuals and especially those over 65 years. Managed health care helps individuals min these programs by enabling them to pay for both the inpatient and outpatient hospital services without having to worry (King 2009). This applies to even those patients with serious diseases whose part of the hospital bill is paid for by the managed care insurance plan.
The managed care insurance plans pay for the nursing services of elderly individuals who are in nursing homes. It pays for the first 20 days for patients staying for 100 days and some individuals may even qualify to be paid for the nursing services for the 100 days. This proves to be beneficial and especially to those individuals without family to take care of them or no retirement funds to cater for special treatment in the old age.