Five types of health care plans

Insurance plans for diabetesAccording to the latest figures from the Centers for Disease Control, 22.3 percent of Americans between the ages of 18 and 64 don't have health insurance. That means more than one in five adults are uninsured. As both health care costs and diabetes diagnoses rise, a lack of health insurance could make managing this chronic condition nearly impossible. According to the 2011 National Diabetes Fact Sheet from the Centers for Disease Control and Prevention, nearly two million new cases of diabetes are diagnosed each year and diabetes costs American patients more than $174 billion dollars annually.

Health care plan options

Thankfully, consumers today can chose from a wide range of health care plans to help them manage the expenses associated with diabetes and other conditions. Right now, there are five major kinds of health insurance in the United States, ranging from traditional indemnity plans to health maintenance organizations. The kind of plan chosen can affect greatly impact the cost of treatment, so many consumers find it's best to weigh their options when purchasing new or changing health care plans.

Indemnity plans. These plans allow patients to use any doctor or hospital and the bill is sent to the insurance company, who pay a certain percentage, usually 80 percent, after the patient reaches a deductible. Many of these plans typically have an out of pocket maximum, which means that all fees are paid by the insurer after the deductible is met. Typically a higher deductible translates into a lower premium. Some indemnity plans have lifetime limits on benefits.

Preferred provider organizations. Known as PPOs, these are managed care plans most similar to an indemnity plan. When a patient sees a doctor within a predetermined network, his or her copay at each visit is a predetermined, fixed amount. Should the patient chose a physician out of the network, the insurance provider typically covers a percentage of the charges, usually between 70 and 90 percent. One thing many consumers like about PPO plans is that they are able to make self-referrals and see any doctor they'd like.

Health maintenance organizations. Commonly called HMOs, these plans rely on care coordinated by a single doctor, usually a general care practitioner. With an HMO plan, instead of paying for each individual service a patient receives, he or she pays a set premium for services from a set range of doctors, hospitals and labs. In addition to premiums, some plans require a patient to pay a small copay at the time of service.

Point-of-service plans. Also referred to as POS plans, they combine portions of PPOs and HMOs. If a patient chooses to direct care through a general care physician, services usually follow HMO-like guidelines. If he or she should choose care though a PPO provider, co-payment is required like those in in-network services. If a patient seeks care outside the PPO and HMO networks, he or she is likely be reimbursed for a portion of the fees by the insurance provider.

Health savings accounts. A newer option, HSAs allow patients to have money for current and future health care in a tax-free account. According to information from the US Department of the Treasury, HSAs were created so that individuals with high deductibles could easily set aside money for health care.

Article sources  expand

About Laura Isaacs

Laura L. Isaacs studied at Indiana University and has worked in print and online media for almost 10 years. Laura has provided health-related content for media outlets including Fox Interactive (via Canvas News and EndPlay). Additionally, she has a family history of diabetes and is passionate about sharing information to help readers cope with this disease.

Sign up for our newsletter
  • Get diabetes supplies
    delivered to your door.
  • Find companies that offer free
    delivery of the brands you want.

  • Diabetes supplies
     CPAP mask and tubing
  • How would you describe yourself?

  • Do you have Medicare as your primary insurance?
  • Yes No

Popular Education Center Articles

Add a comment
Google Plus
(required) *
(required,will not be displayed) *
Can't read this?
Get two new words
Listen to the words