Health insurance plans have their advantages and disadvantages. Managed care plans are the most restrictive health care plans. Consumer Driven Health Plans (CDHP) are newer health plans introduced in 2001. CDHP’s are considered high deductible health plans with a health savings or health reimbursement accounts attached to them. The differences between a PPO and CDHP plans are the CDHP has the HSA or HRA, and also give consumers more control over their health care dollars, as well as incentives to use preferred providers in these plans. The participating providers compete to keep cost down and improve quality as the consumer has a choice based on these conditions, and how they select care provider and services. There are critics that believe
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There are HMO’s, PPO, EPO’s, POS, and now CDHP plans. It can be complicated and difficult for some. It requires consumers to be quite savvy in interpreting what their insurance plans mean, and how much their deductibles and out-of pocket costs are. There are advantages and disadvantages to all of these plans. CDHP are newer health plans which will be discussed, as well as, the differences between a PPO and CDHP plans and how they control costs and improve quality of care.
Let’s start by discussing the major criticisms or drawback to managed care. First you have to select a primary care provider who needs to be the gatekeeper to all your care. You need to get a referral for any subspecialty care, and wait until it is authorized before being seen by a specialist. You need to stay within the network of providers associated with the plan to have in-network coverage. This plan does not have much flexibility in regards to who the member can choose for their health care …show more content…
Members typically pay a higher percentage of the cost for out-of-network care (Andrews, M. 2014). PPO’s may offer very different out-of-network coverage than another. Members are not required to have a Primary Care Provider (PCP), and in most cases, do not need to be referred to a specialist by the PCP. They can have different levels of coverage with different tiers of in-network and out-of-network benefits with increased share of cost, if an out-of-network provider is chosen. Some PPOs plans don’t offer out-of-network services at all. On the other hand, some HMOs have an out-of-network option that makes them seem similar to PPO’s (Andrews, M. 2014). In 2014, HMOs and PPOs dominated the plans offered by insurers on the health insurance exchanges. According to an analysis of plans sold in the 36 states for which the federal government runs, HMO’s and PPO’s made up 40 percent offered, POS plans made up 12 percent and EPO plans 7 percent (Andrews, M. 2014). The differences between managed care plans like a PPO to a CDHP regarding the choice of providers, covered benefit, a level of cost sharing in most cases there is not difference when it it comes to choosing providers with PPO and CDHP. They both function as a PPO plans but the CDHP is considered a high deductible plan, and the member does not need to choose a PCP. The member has greater
There are HMO’s, PPO, EPO’s, POS, and now CDHP plans. It can be complicated and difficult for some. It requires consumers to be quite savvy in interpreting what their insurance plans mean, and how much their deductibles and out-of pocket costs are. There are advantages and disadvantages to all of these plans. CDHP are newer health plans which will be discussed, as well as, the differences between a PPO and CDHP plans and how they control costs and improve quality of care.
Let’s start by discussing the major criticisms or drawback to managed care. First you have to select a primary care provider who needs to be the gatekeeper to all your care. You need to get a referral for any subspecialty care, and wait until it is authorized before being seen by a specialist. You need to stay within the network of providers associated with the plan to have in-network coverage. This plan does not have much flexibility in regards to who the member can choose for their health care …show more content…
Members typically pay a higher percentage of the cost for out-of-network care (Andrews, M. 2014). PPO’s may offer very different out-of-network coverage than another. Members are not required to have a Primary Care Provider (PCP), and in most cases, do not need to be referred to a specialist by the PCP. They can have different levels of coverage with different tiers of in-network and out-of-network benefits with increased share of cost, if an out-of-network provider is chosen. Some PPOs plans don’t offer out-of-network services at all. On the other hand, some HMOs have an out-of-network option that makes them seem similar to PPO’s (Andrews, M. 2014). In 2014, HMOs and PPOs dominated the plans offered by insurers on the health insurance exchanges. According to an analysis of plans sold in the 36 states for which the federal government runs, HMO’s and PPO’s made up 40 percent offered, POS plans made up 12 percent and EPO plans 7 percent (Andrews, M. 2014). The differences between managed care plans like a PPO to a CDHP regarding the choice of providers, covered benefit, a level of cost sharing in most cases there is not difference when it it comes to choosing providers with PPO and CDHP. They both function as a PPO plans but the CDHP is considered a high deductible plan, and the member does not need to choose a PCP. The member has greater