Selecting the ideal health care insurance is a crucial decision that will shape your family’s future. To understand all of the available coverage options and how they function, it’s essential to become educated on them.
HMO and PPO plans provide members with access to a network of doctors and hospitals. Not only are these plans more economical than going out-of-network, but they often include cost sharing discounts for lower income individuals.
Professional Healthcare Services
Health care insurance is a highly regulated industry that is overseen by both state and federal authorities. The federal government administers Medicare and Medicaid, while states oversee privately regulated plans such as high-risk pools within their boundaries.
Healthcare insurance provides protection to enrollees by pooling their risks with those of others in a plan. This combination of risks makes medical care much more accessible for most people.
In a nutshell, healthcare services encompass everything from inpatient and outpatient hospital care, physician-provided medications, lab work and diagnostic procedures. Primary care is perhaps the most well-known type of health care; this involves visiting a doctor or other healthcare professional to address symptoms and medical concerns. Some providers also perform more specialized services like surgery or rehabilitation. To get an all-inclusive picture of what benefits are available for you and your family members, inquire with your employer which ones they provide.
Primary Care
Primary care is often the initial point of contact for individuals or their families with the healthcare system and an integral component in maintaining good health. Primary care physicians strive to prevent disease by monitoring diet, managing stress and teaching patients how to manage chronic illnesses like diabetes and heart problems.
Your doctor may coordinate your care with specialists when necessary. They may suggest screening tests to detect issues before they become serious (e.g., mammography for breast cancer) or give you vaccinations like the flu shot.
One of the most desirable aspects of primary care is a long-lasting partnership that forms between patients and clinicians. This relationship fosters trust, confidence, as well as an obligation to guide patients through the healthcare system – essential for navigating patients through often confusing pathways towards better health.
Preventive Care
Maintaining preventive care can help you stay healthy, avoid or delay illness, and detect issues early when treatment is most likely to be successful.
Preventive services include routine physical exams, screenings, vaccines and counseling with your doctor about ways to maintain good health habits. Not only that, but these services can save you money too!
Under the Affordable Care Act and federal guidelines, most medical plans must cover a wide range of preventive services at no cost-sharing – including visits with your primary care provider.
Before signing up for any plan, it’s important to verify which services are covered.
Adults and children alike need regular health screenings, immunizations and annual check-ups to stay healthy and detect problems early. Our preventive services guidelines offer recommendations based on age and risk factors; speak to your doctor about which screenings are right for you and your family.
Specialty Care
Specialists are problem-oriented professionals who provide care to individuals with specific health conditions. They do so through several core activities: consultations (sharing advice with another clinician), co-management (sharing long-term management of a problem), principal care (assuming total responsibility for an issue), primary care (providing a medical home), and procedures.
Unfortunately, the current structure of specialty care in America makes it less accessible, increases costs, erodes patient experiences, decreases effectiveness and places a strain on specialists and staff. By unbundling and optimizing the various services that specialists offer, these outcomes can be improved and patients’ needs met more effectively.
Access to specialized care is essential for improving the healthcare experience for all Americans. Unfortunately, many people in rural and low-income areas lack these providers, leading to delays in treatment, recurrences of chronic conditions, and diminished quality of life.
