Medical Coverage Plans

Point-of-Service Plans (POS)

A Point-of-Service managed care plan is generally an HMO with a significant difference: the patient can

assign him or herself outside of the network and still have services covered. These plans generally cost

a bit more than a standard HMO for the flexibility cost.

Preferred Provider Organizations (PPOs)

As a hybrid of the HMO and the fee-for-service, the Preferred Provider Organization managed care

plan allows a choice of cost for the patient. A network of providers that are “preferred” is given to the

patient and if used, the plan will pay for the majority of expense. However, especially for rural patients,

if a provider is not in the network coverage is still allowed. The copayments may just be larger. Similar

to the HMO there are no forms and authorizations to obtain prior to service. The patient uses an

identification card. Shared costs and deductibles can be included, however.

Conclusion

Managed care plans come in enough variety

that there is generally a plan that works for just

about everyone. Very few will work 100 percent

perfect. This simply does not happen under a

managed care plan concept. It runs counter to

the idea of a plan being managed for

efficiencies. But that said, with enough research

an applicant can easily determine which care

plan type works best for his or her individual

needs.

Ultimately, the best managed care plan is the

one that fits your specific needs the best. While

referrals help significantly, you will still need to

make a decision as to how best a plan services

your specific needs.

Do the research, talk with people, and get the feedback. It can save you a boatload of difficulties by

avoiding the wrong managed care plan.