Identify and describe the three types of health insurance in the U.S.
The three main types of insurance in the United States include the Individual Health Insurance, Group Insurance and State Sponsored Insurance. The Individual Health Insurance policies allow the policy holder to hold health coverage on themselves, their spouse and dependants. It is usually more expensive that other insurances offered however. This type of insurance is tax deductable. With this type of insurance you are able to choose the coverage needed for your lifestyle. As long as the policy holder pays the premiums due they do not run the risk of prices going up as in group health insurance where the employer has the ability to pick and choose what coverage’s they are willing to use on their plans offered to the employees. The Group Insurance is offered to employees at a rate the employer chose. The insured can choose coverage for themselves or for family coverage. The benefits can include a lesser cost insurance since the employer pays a portion of the costs, better coverage in health care needs and the insured and their family members will not be excluded due to preexisting conditions. The last of the three is the State Sponsored Insurance which includes Medicare and Medicaid coverage for low income families and senior citizens. This coverage is usually a free insurance or low cost that covers 100% of health care needs and medications.
Describe the three methods for categorizing of health insurance in the U.S. Indemnity insurance also known as the free-for –service is the first type. With this insurance you get to choose what doctors you see, what hospitals you go to and types of services you want for your health care needs. As long as the desired service you chose is set for your needs this insurance can benefit the insured. The insured will pay a high payment annually, (deductible) and a portion of hospital bills called a co-payment and the insurance will pay the rest. It is not the best choice for someone who is needing constant care from a doctor and regular check-ups as this will cause the insured to go over their plan and cause out-of-pocket expenses after their deductible has already been met. The Managed Care plan offers a little less flexibility in the way you are taken care of. The insured must chose a primary doctor that is covered under the plan and go to the hospital only allowed by this insurance. When the insured is sent to a specialist a referral must be sent in first to approve this before the person is allowed to be seen or no coverage will be provided. The last insurance, the Health Savings Account allows the insured to pay for current costs as well as save up for future needed expenses in coverage. This type of insurance is tax free and is has two parts, the insurance and the savings it provides for future coverage.
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 three main types of managed care plans are health management organizations (HMO), preferred provider organizations (PPO) and point of service (POS). The HMO’s generally have a fixed rate plan and has a low raised cost in the terms of increases. The insured with this type of insurance chooses a primary care physician as their main contact for health care needs. This physician however, has the burden of having to refer patients to a specialist before they are accepted by the insurance. This often will increase paperwork and time on the staff to send in referrals and wait for the approval before being able to schedule an appointment for the patient. The patient must contact their primary care physician before any other medical needs are met and often means having to make an appointment in order to get the referral needed. The PPO insurance coverage is a group within a specific network. The policy is offered at discounted rates and in return the sponsor creates incentives for the policyholder to use the physicians and facilities within the PPO network. PPO physicians provide medical services to the policyholders, employees or members at discounted rates. In return, the sponsor creates incentives for employees or policyholders to use the physicians and facilities within the PPO network. This type of insurance the member is usually reimbursed for expenses outside of the co-pay made. The bill is sent directly to the insurance company and the bill is then paid to the doctor. The doctors and the PPO are who set the cost of services provided. The POS plan is a type of managed healthcare that combines characteristics of the HMO and the PPO. Much like the HMO you pay no deductible and usually only a low co-payment when you use a healthcare provider within the network. The insured chooses a primary care physician who is responsible for all referrals within the POS network. The insured can choose to go outside the network for care but will likely have to pay a deductible and the co-pay will include a certain percentage of the total cost.

Describe the impact of managed care on both the Medicare and Medicaid programs.
Medicare is offered to the senior citizens and to those with a proven disability. This type of coverage is aimed towards preventative and primary care. This coverage usually comes with a deductible and has a limit to some point where it will cap its maximum coverage and the insured is often forced to search out a second type of coverage to offset the out of pocket costs such as medicines and hospitalization. With the medical field growing over the past 80 years this type of coverage is seen more and more due to the elderly living longer. The physicians are burdened with the routine scheduling in order to cover all the necessary needs from the elderly. The Medicaid programs offered to low income and unemployed enrollees often burden the physicians’ offices with a lot of medical services with a low cost reimbursement for these services. The Medicaid insured is able to get the health care needs met but the burden of finding a physician to accept this type of insurance is bothersome due to the low payments to the physicians. The clinics available for this insurance are often busy and hard to get in if you need a quick visit for simple colds and illnesses. With the increased unemployment in the U.S. this type of insurance is becoming more and more popular. http://efinancedirectory.com/articles/Three_Types_of_Health_Insurance%3A_Indemnity,_Managed_Care,_Health_Savings_Accounts.html http://www.termpaperwarehouse.com/essay-on/Health-Care-Classification-In-The-United/50626 http://www.aarphealthcare.com/understanding-health-products/individual-health-insurance/managed-care.html http://www.foreignborn.com/self-help/health_insurance/4-what_types.htm
http://www.healthinsuranceinfo.org/health_insurance_types.html