Managed care models and the types of health insurance plans in the U.S play a role in ensuring quality health services. They include the HMO (Health Maintenance Organization), family doctor, and the Telmed model. HMO acts as an alternative for basic health insurance. Therefore, policyholders must consult an HMO practice after the first illness. Various health insurance regulations protect patients in all managed care models. However, HMO policyholders cannot consult an HMO practice for emergencies, annual gynecological preventive check-ups, and eye tests. Those who choose the family doctor model can only consult the ‘gatekeeper.’ General features of managed care models include both the regulation of the entire health care provision process and the interconnectedness of treatment facilities.
managed care models and the types of health insurance
WHAT ARE THE VARIOUS TYPES OF HEALTH INSURANCE PLANS?
Patients have a choice when it comes to different types of health insurance plans. Each plan offers various benefits that include bronze, silver, gold, and platinum. Bronze plans have the least coverage, and platinum plans have the most. Patients under thirty years can also choose high-deductible, catastrophic plans. Most people opt for managed care models, therefore,the costs and details of each insurance plan vary. Additionally, deductibles vary, with the least expensive carrying the highest deductible. For platinum covers, beneficiaries pay 10% deductibles while the cover pays the remaining 90%. Common plans under health insurance regulations are HMOs, Preferred provider organizations (PPOs), and Exclusive provider organizations (EPOs). Others include Point-of-service (POS) plans and High-deductible health plans (HDHPs), linked to health savings accounts (HSAs).
the various types of health insurance plans
HEALTH INSURANCE REGULATIONS IN THE UNITED STATES
Health insurance regulations work to govern the processes and operations of healthcare institutions and other managed care models. The major Acts implemented regarding healthcare include the Affordable Care Act of 2010, Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Others include the Hospital Readmissions Reduction Program (HRRP), Health Insurance Portability and Accountability Act (HIPAA) of 1996, the Healthcare Quality Improvement Act of 1986 (HCQIA), and the Patient Safety and Quality Improvement Act (PSQIA) of 2005. These provisions made in these regulations pertain to all types of health insurance plans. The Medicare program provides insurance coverage for about fifty million Americans. Medicaid covers various recipients, such as uninsured expectant mothers, temporarily unemployed workers, and disabled individuals.
health insurance regulations in the United States
Additional attachments
>> Download
