Showing posts with label Managed Care. Show all posts
Showing posts with label Managed Care. Show all posts

Monday, April 12, 2010

Difference between HSA and PPO




HSA vs PPO

HSA - Health Saving Account

PPO - Preferred Provider Organization

With health care and medical costs continuing to rise, it is even more essential for every individual to have health care insurance. Fortunately, in the United States, you do have a lot of options when it comes to the type of health care that you will receive, depending on the type of health care insurance that you have. Here, we will take a look at the difference between using your HSA, or a Health Saving Account, and acquiring the services of a PPO, or a Preferred Provider Organization.
As the name implies, an HAS is a health savings account, the plan holder of which will be entitled to tax-advantages. An HSA is only available for those who are enrolled in a High Deductible Health Plan. When you have an HAS, the funds deposited to your account will not be subject to federal income tax.
On the other hand, a PPO is actually a managed care organization, which consists of hospitals, medical doctors and health care providers who have an agreement with an insurance company. The agreement allows the health care provider to offer services to plan holders at reduced rates. A PPO is a subscription-based arrangement for receiving medical care, while an HSA is typically paid for by a person’s employer.
An advantage that HSAs have over PPOs, is that if you do not use the funds that accrue over time, you can still use the increased amount for future medical expenses. So essentially, you get to keep the funds that are not spent. This is not the case with a PPO, which has a different set of rules for the funds that you do not use for your health care needs.
Both the HSA and PPO can be used for prescription drugs, dental or vision services, long-term care premiums and charges for medical expenses which are otherwise not covered. To determine whether it will be more beneficial for you to use HSAs over PPOs, you can go online, and look for rate calculators to help you find out which one will best suit your medical and financial needs.

Summary:
1. HSA is a health savings account, while PPO, or Preferred Provider Organization, is a group consisting of doctors, health care providers and hospitals.
2. HSA offers tax deductions, while PPOs do not.
3. HSA can be fully or partially paid for by your employer, while PPO is usually self-funded.

Difference between HMO vs POS




Difference between HMO vs POS

POS, or Point of Service, and HMO, or Health Maintenance Organization, are the various types of Managed Healthcare Plans in the US. These health care insurances help the employees with their medical bills.
When considering a HMO plan, it is more restrictive than the POS. A person who has taken a HMO plan, has to opt for a Primary Care Physician (PCP) from the network of contracted doctors in his area. It is the Primary Care Physician who coordinates the employees’ medical care. In the case where an employee has to seek the help of a specialist, the PCP will make a referral, with whom the costs are minimised.
The Point of Service can be said to be a hybrid of HMO and PPO (Preferred Provider Organization) plans. The POS is a more flexible plan than the HMO. Employees choosing a POS plan can seek any doctor within, or outside, the network of contracted doctors.
One of the main differences between the two medical insurance plans, is that an employee opting for POS plan can have the benefits of both POS and HMO plans. On the other hand, the HMO plan has very strict guidelines.
Another difference is that there is no need to choose a PCP in a POS plan, whereas, it is needed in a HMO plan. If an employee does not have a PCP when he has a HMO plan, then he or she will shoulder the entire bill. On the other hand, if there is no POCP under a POS plan, then he or she will just have to pay a coinsurance.
In case of HMO plans, one needs to get a referral by the PCP in order to consult a specialist. On the other hand, if an employee has taken a POS plan, he can directly approach a specialist of his desire.
Summary:
1. An employee opting for the POS plan can have the benefits of both POS and HMO plans. On the other hand, the HMO plan has very strict guidelines.
2. The POS is a more flexible plan than the HMO.
3. Another difference is that there is no need to choose a Primary Care Physician in a POS plan, whereas, it is needed in a HMO plan.
4. One needs to get a referral by the PCP in order to consult a specialist. On the other hand, if an employee has taken a POS plan, he can directly approach a specialist of his desire.

Difference between PPO and POS




PPO vs. POS

Today, more and more people are becoming health conscious. People are now considering the various options to assure themselves that they will be covered when it comes to times of sickness. In this regard, many managed health care plancome into play. If you have heard of the terms HMO, PPO and POS, then perhaps you are not that alien to these very commonly managed health care schemes. With regard to the last two plans mentioned above, the PPO is completely known as the Preffered Provider Organization, whereas the POS is the Point of Service Plan.
So what are the terms of the POS? The POS strategy is just like the HMO, because you have a primary care physician whom you can readily visit free of charge. You are free to go outside of your network of providers, even without visiting your primary care physician. However, you will have to pay a bigger sum per visit to each of the unaccredited (non POS) providers. Clearly, you can save more money if you just stay with the services from the providers within the POS network. You are also tasked to file for your reimbursement claims yourself for expenditures outside of the POS.
PPO, on the contrary, is an association of medical practitioners (like hospitals or doctors themselves) that render healthcare services to their target firm or group of clients. These PPO associations are either backed by stable organizations or big insurance companies. The key feature with PPO is that you no longer have to seek referrals from your primary care physician. Those who are members of the PPO also have the option to opt for providers (doctors) outside of the PPO network. Most often, the insurance company sponsoring your PPO will only reimburse the full amount of your expenses if you avail of PPO certified providers. Otherwise, you will only get back about 80% of what you have spent if you choose those medical practitioners who do not belong to your PPO association.
Moreover, one of the clear advantages of the PPO plan is that you have an ‘out of pocket expense’. This means that your expenditures must reach the maximum, or ceiling amount, for the insurance company to pay you the full expense cited in your PPO’s availment policies. Expenses like deductibles, as well as your payments for co-insurances, are included in this out of pocket expense cap. Obviously, your monthly insurance premiums are not counted.
Overall, both plans contribute to a more comprehensive approach to providing healthcare to their members. However, needless to say, just make sure that you consider all the options in terms of your plan’s coverage policies, costs and overall convenience of services. Here is a summary of the differences between PPO and POS plans.
1. With a PPO, the co-pay is much higher compared to POS plans
2. PPO also has an out of the pocket expense, and you need not seek referrals from your primary care physician.
3. POS plans are more like HMO plans.

Difference between PPO and EPO




PPO vs EPO

Definition

PPO stands for Preferred Provider Organization, or Preferred Provider Option.

EPO stands for Exclusive Provider Organization.


There are many insurance systems created all over the world to try and make sure that people get their medical treatments at very reasonable rates. It is difficult to predict when you are going to get sick and when you are going to need medical attention, and it is therefore very important to be properly insured. However, due to the overwhelming possibilities available, trying to figure out which one is the best, and how they function, is not easy. For example, let’s look at the systems in the United States – the PPO and EPO insurances.
Technical Differences· A Preferred Provider Organization is run by Medical Doctors, Medical Health providers and other health care organizations that take an insurance premium from the customers and provides them with an insurance policy through a third party organization.
· An Exclusive Provider Organization provides the same kind of insurance plans, however, on a smaller scale. The providers that work with them offer larger amounts of discount for their services.
What does it mean for the patient?
· In the case of a Preferred Provider Organization, people have more flexibility when it comes to choosing the primary care doctor of their choice. Also, they do not need to contact their doctor to get an appointment with a specialist health provider. The fees for the insurance premium is higher than that of the EPO, however, it is only by a very limited margin.
· With an Exclusive Provider Organization the company will choose the primary health care provider for you, and you will have to follow his advice and instructions. It is only when that specific doctor agrees to some kind of treatment that you will be able to get the insurance necessary. The fees are not negotiable, and if you decide to stop the insurance process you will have to pay all the pending bills that the company may have with you.
There is very little difference between the two systems, and it becomes extremely difficult for people to really understand the real meaning of the two of them, however, it is important to study their differences properly.
Summary:
1. A PPO and EPO are medical insurances that are being run by a third party, or an organization.
2. PPO has a vast network of professional providers that function as per their rules and regulations.
3. EPO is a much smaller network, and it does not have so many health care providers.
HMO vs EPO
HMO and EPO are both health insurance schemes. HMO stands for Health Maintenance Organization, and EPO stands for Exclusive Provider Organization. Well, there are several technical differences between HMO and EPO.
When considering their difference, the HMO can be termed as an insured product, which means that the insurance company will pay the costs of the claim. On the other hand, the EPO can be termed as a self-insured product, where the employer has to pay the costs.
In terms of flexibility, the Exclusive Provider Organization is more flexible than the Health Maintenance Organization. In the case of Health Maintenance Organization insurance, a referral from the Primary Care Physician is required. It is the PCP who manages all the medical services and provides referrals. On the contrary, for Exclusive Provider Organization insurance, there is no need for a referral from a Primary Care Physician.
An HMO also requires that the insured person stay within the network of the providers. This is the same with EPO insurance, therefore, there is no out of network coverage for both insurance schemes.
An HMO plan generally has a vast network of doctors, whereas the EPO has only a limited network of doctors.
When comparing the premiums, the EPO has a lower premium than the HMO. The HMO is determined on a capitated basis, whereas the EPO is based on the services provided. When considering their coverage, the EPO is better suited for the rural areas.
The Health Maintenance Organization is regulated under the HMO laws and regulations. The Employee Retirement Income Security Act regulates the Exclusive Provider Organization.
Summary:
1. The Exclusive Provider Organization is more flexible than the Health Maintenance Organization.
2. In the case of Health Maintenance Organisation insurance, a referral from the Primary Care Physician is required. A referral from a Primary Care Physician is not needed for EPO insurance.
3. HMO can be termed as an insured product, which means that the insurance company will pay the costs of the claim. EPO can be termed as a self-insured product, where the employer has to pay the costs.
4. When comparing the premiums, the EPO has a lower premium than the HMO.
5. The Health Maintenance Organization plan generally has a vast network of doctors, whereas the Exclusive Provider Organization has only a limited network of doctors.
6. Unlike the HMO, the EPO is better suited for the rural areas.

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