Texas Health Insurance – Fee-For-Service Health Plans

Living in Texas, you can get a serious illness at any time. Having this affliction along with injuries and the like can cost a lot of money to treat. Health care insurance in Texas is important to have. You need to have enough health care coverage that not only covers just you, but also your family.

Having health care insurance in Texas can prevent you from having financial difficulties. It will help you cover the majority if not all of your expenses related to illness, injuries and doctor visits. In order to do that, you must look for health care coverage that will meet the needs of you and your family.

When you have a health care plan, there are two categories that it can fall under. There’s fee-for-service or managed care. For this article, we will discuss fee-for-service health plans. Health care insurance in Texas can consist of group coverage. This would include employers or organizations that provide health care coverage to their employees or members. If you don’t fit into either of those groups, you can purchase individual health coverage from an insurer or independent agent. Whichever plan you get, check out the benefits that come with it. They are different and you may have to pay more of a difference from one than you would with the other.

Fee-for-Service Health Plans

These plans, which are also known as indemnity plans, can be purchased from independent insurance companies. This insurance plan allows you to see any doctor of your choosing. The good thing about this plan is you can also see a specialist of your choosing without needing a referral, which can delay the process. If a referral were required, you would have to wait a while. It’s a good thing that the health insurance in Texas has an option of what you can choose from.

With this health insurance in Texas, you are covered for the majority of the costs in regard to medical treatment and related medical issues that the policy covers. You will be billed for the out-of pocket items that the insurance did not cover. Once you pay the out-of-pocket fees, submit your claim to the insurance company for reimbursement.

With this kind of health coverage, you would be required to pay a fee to keep the plan going. If you have this health insurance in Texas through your employer, more than likely it will be deducted from your regular pay. However, it will only be a portion because employers usually help to offset the cost for employees by paying their share.

With most of not all health insurance in Texas, you will be required to pay a deductible for certain medical requirements. After that, the insurance will start paying their portion. Every year that you have the plan, you are required to pay a deductible. You can get lower insurance premiums by making your deductible higher. With fee-for-service insurance plans, there is also the matter of co-insurance. Some plans may pay 70 percent or higher with you paying the remainder. In the state of Texas, after you have satisfied the deductible, they pay at least half if not more of the medical services that are covered under this plan. You will need to thoroughly look at this plan to see if this is something that you would be feasible for you and your family.

Health And Medical Insurance – Comparing Managed Care Health Plans

Health insurance plans have been forced to take action to contain costs of quality health care delivery as health care costs have skyrocketed. Health insurance premiums, deductibles and co-pays have steadily increased, and health insurance companies have implemented certain strategies for reducing health care costs. “Managed care” describes a group of stratgies aimed at reducing the costs of health care for health insurance companies.

There are two basic types of managed care plans; health maintenance organizations, or HMOs, and preferred provider organizations, or PPOs. So which health plan is best? How do you choose what type of health insurance best suits the health care needs of you and your family?

Both HMOs and PPOs contain costs by contracting with health providers for reduced rate on health care services for its’ members, often as much as 60%. One important difference between HMOs and PPOs is that PPOs often will cover the costs of care when the provider is out of their network, but usually at a reduced rate. On the other hand, most HMOs offer no coverage for health care services for out-of-network providers.

Both HMO and PPOs also control health care costs by use of a gateway, or primary care provider (PCP). Health insurance plan members are assigned (or select) a primary care practitioner (physician, physician assistant, or nurse practitioner). usually a family practitioner or internal medicine doctor for adult members or a pediatrician or family care practitioner for childern. The primary care provider is responsible for coordianting health delivery for plan members. Care by specialist physicians require referral from the primary care provider. This cost containment strategy is intended to avoid duplication of services (for example, the cardiologist ordering tests that have already been done by the PCP, or a sprained ankle being referred to an orthopedic) and avoid unnecessary specialist referrals, tests and/or procedures.

HMO and PPO plans also contain costs by requiring prior approval, prior authorization, or pre-certification for many elective hospital admissions, surgeries, costly tests and imaging procedures, durable medical equipment and prescription drugs. When such services are required, the provider must submit a request to the health insurance plan review department, along with medical records that justify the service. The request is reviewed by the health insurance company to determine whether the services are justified as “medically necessary” according to the health plan policy and guidelines. Review is usually performed by licensed nurses, and, if the reviewer agrees that the service is necessary, approval is given and the service will be covered by the health insurance plan.

As health care costs continue to rise, many indemnity health insurance plans, or “fee for service” plans are being forced to adopt some managed care strategies in order to provide quality health care and keep health insurance premiums affordable. And as long as health care costs continue to rise, the distinctions among PPO, HMO, FFS and other health insurance plans will become blurred. Rest assured, however, that managed health care is here to stay

Health Insurance: Health Savings Account

Health insurance is a critical part of our health care system. For those that are lucky enough to have health insurance, they know that it shouldn’t be taken for granted. For a large number of the unfortunate who don’t have health insurance for their families, do so at great risks.

Health insurance has long been a popular political subject for our country. There are many that fill health insurance should be socialized. There are just as many feel it should be kept private. While both parties may have sound arguments, we have to accept what is available to us. So, unless you’re a government employee, or one of the dwindling corporate employees still receiving health insurance, you need to go out there and get it on your own.

There are a number of health insurance choices that should suit your specific needs. A Health Maintenance Organization, or more commonly called HMO, is one popular health insurance choice. HMOs are one of the most common forms of health insurance provided by employers. They allow you to visit a pre-selected hospital, doctors, or clinics, without restriction. This may or may not be totally covered by your employer, but usually comes at a fixed monthly cost.

The Preferred Provider Organization, or the PPO, is similar to the HMO concept. With the PPO, you are not forced to get a little dig their doctor or hospital. When you do, however, you receive a discount for doing so. This system works on the reimbursement, philosophy. Essentially, you are reimbursed by your insurance company after services are rendered. Sometimes, they will bill your insurer at the time of service.

Indemnity health insurance plans are eight other top and plan that has become quite popular these days. One reason is, you are able to choose any position or hospital you choose. The drawback to this of course is that it comes at a premium. In addition to higher costs ease typically require a larger deductible. For the hypochondriac this may not be the best choice. Those that like to make lots of visits to hospitals might find other plans more suitable. But for those that have to be on their deathbed to see a doctor, this may be an appropriate plan.

The Health Savings Account, HSA, has some similarities to the indemnity health insurance plans. As the Health Savings Account is probably most suitable to the individual that doesn’t require a lot health care, or checkups. These individuals, which most commonly are men, may find the Health Savings Account to be a good choice for them.

Health Savings Accounts are a way to both have a way to save and pay for medical expenses. Any contributions that are made to the Health Savings Account that go unused for medical purposes are retained in a savings account. This savings account can hold many popular investments, such as mutual funds. So, getting back to the individual that avoids medical care, this individual gifts for both best of both worlds. They get the protection of the much-needed health insurance. This provides protection against large medical or accident issues. But, if these funds go unused, they get the benefit of putting the money away for retirement. Any after-tax dollars that are contributed to the Health Savings Account can be detected, up to $2900 for 2008.

Choosing a health insurance plan may seem like a very confusing process. There is no open and shut method of choosing the best health insurance. Each individual is different, with different health needs. The most important step here is to get some form of health insurance. Go in without adequate health insurance puts you and your family at tremendous risks. And those risks just aren’t worth the possible consequences.