The health care industry consists of a large number of different medical players who offer a wide range of health care services. While Medicare and Medicaid are state-and federal-funded programs, private entities make their own arrangements for offering health care coverage. Private health care plans can either be purchased by an individual health care provider to provide health care coverage or be purchased by an employer and enrolled in the health care plan. Because of the differences in the structure of these two types of health care plans, each health care provider may have different rules governing enrollment.
Health insurance plans provide coverage for a variety of services that are usually not covered by Medicare or Medicaid. Health care providers are required to offer at least standard benefits, which include doctor visits, hospital stays, emergency care, prescription drugs, health care cards, and mental health services such as therapy. Some health insurance plans also cover dental services, disability income, accidental death and critical illness coverage. However, these benefits are often not offered at an affordable rate by every health insurance provider. Health care insurance providers also vary greatly in terms of their costs and coverage for covered services and procedures.
One type of health care plan that many people are familiar with is a pharmacy benefit. A pharmacy benefit plan may pay cash for items purchased at a participating pharmacy. This is often the most affordable option available to patients who need health coverage but do not want to take out a policy through their employer or because they do not qualify for Medicaid or Medicare. Pharmacy benefit plans can also cover non-prescription drug costs, as well as hearing and vision benefits.
Another type of health insurance plan popular with patients is fee-for-service plans. Under fee-for-service plans, an insurer agrees to cover the costs of medical services provided by doctors and other licensed health care professionals, up to a prescribed cap. Doctors and other providers can agree to set their own fees for medical services. Patients pay co-payments for services received. They do not pay any of the costs associated with health care services received from professionals who are not in an agreed group.
Managed care plans are another type of managed health care plan. In a managed care plan, a consumer selects a doctor and a group of doctors, opts for a network of doctors, pays copays and deductibles, and chooses a durable medical care policy. A patient has a choice among a number of health care providers. In addition, if a patient has a physical disability or a serious illness, Medicare and Medicaid will cover a portion of the costs of medical care, depending on the level of coverage selected.
Most managed care plans allow a consumer to choose between an indemnity plan and a co-pay plan for medical care. An indemnity plan allows the consumer to choose a doctor and hospitals that accept Medicare. If a person gets sick and requires medical care, they will be responsible for all expenses out of pocket. An indemnity plan will cover the expenses only if the consumer has chosen a service provider prior to getting sick. Co-pays for medical services are required when getting services from a hospital.
The insurance plans generally offer better coverage than the policies offered by private health insurance companies. Some insurance companies only cover certain services and procedures. They also limit the services that are covered and usually cannot be considered emergencies. Some insurance plans require individuals to undergo a waiting period before they are allowed to use them. Other insurance plans prohibit discrimination against individuals with pre-existing conditions. The managed care plans allow all individuals to use them.
The state of Maryland has placed a minimum essential coverage law in effect. This requirement prevents health insurance plans from excluding individuals based solely on their medical history. The act also requires companies to offer more affordable care act plans. Blue Cross Blue Shield is one of the Maryland insurers that follow the standards imposed by the national blue cross association.