Health insurance plans today fall into two broad camps – traditional indemnity health insurance (which tends to be expensive) and managed health care insurance (which tends to be more affordable). The best known form of managed care is that provided by the Health Maintenance Organizations (HMOs) which are designed to provide a moderate level of medical care at a relatively low price.For most people the thought of being able to obtain medical care for a relatively low price sounds attractive but, unfortunately, this can be very much a case of you “get what you pay for” and, unless you go into managed care with your eyes wide open, you could be disappointed with the quality of the care you receive.Managed care works by strictly controlling costs and this, in turn, means controlling access to care. A health maintenance organization is essentially a network of healthcare facilities (doctors, hospitals etc.) whose services are contracted for an agreed fee.Although the term managed health care should mean that health care is managed, in reality it is often said to be more a case of policyholders being managed, as they are largely required to seek their healthcare within the HMO’s network and normally access to such healthcare is controlled by one doctor to whom the patient is assigned. This often means that patient choice is severely limited and that a policyholder may have to join a waiting list for treatment.In certain very limited circumstances policyholders will sometimes be permitted to seek treatment outside of the network but, where this occurs, the HMO will often require the policyholder to pay any costs that are considered to be above those which the HMO considers reasonable and customary for the treatment in question.Against this background, why would anybody choose managed health care in preference to indemnity health insurance other than for reasons of simple cost?The major difference between indemnity insurance and the managed care model lies in the cover provided. Indemnity insurance is designed to cover the policyholder against unexpected, and often very high, medical bill arising out of serious accident and illness. Managed care on the other hand focuses its attention on providing preventative care and aims to keep policyholders healthy by assisting with the costs of routine medical care including such things as vaccinations and check-ups.There are clearly many situations in which one form of insurance would be more suitable than another but, for example, if you are married with a young and growing family then you might well feel that a focus on preventative medicine, particularly for your children, would make managed care a good choice.
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