Medicare, Medicaid, and a Private Insurance-Health Maintenance Organization

Medicare, Medicaid, and a Private Insurance-Health Maintenance Organization (HMO)

Government Versus Private Funding: Health Maintenance Organization (HMO)

Describe how this insurance is paid for. Who pays for it?

A Health Maintenance Organization (HMO) is an organization that provides health insurance coverage for a fee. This fee is usually paid annually or monthly (Hayes & Catalano, 2022). HMO requires that its members pay for part of the total expense of their care.

Who is eligible to have this insurance? Why?

HMO insurance plan is only available to persons who work and live within the network’s service area. HMO insurance coverage network is narrow but provides point-of-service options covering more expansive spaces. The point-of-service options allow individuals to use a point of care outside the defined HMO networks.

How does the insurance work? (Co-payments, Deductibles, Premiums, Capitation, etc.?

HMO insurance plan requires members to cater for part of their healthcare expenses. This care plan limits coverage to a network of providers this organization contracts. Co-payments and coinsurance apply for this insurance plan, with members paying some amount off their pockets to cater for their total care expense. HMOs provide premiums lower than traditional health plans since these organizations provide networks for healthcare providers and channel clients to them (Hayes & Catalano, 2022). Persons using this care plan must pay an annual or monthly deductible before their insurer starts covering their healthcare needs.

Give an example of a healthcare service covered under this insurance type. Evaluate how the service is paid for and what is needed for the individual to obtain the service.

HMO provides for a variety of healthcare services. Eyecare, hearing care, dental care, and health and wellness programs are some of the benefits that confer this insurance plan advantages over traditional care plans. The insurer partly covers these services. An individual, however, has to pay whenever they receive these services as defined in the insurance coverage plan. However, Referrals are required for specialist review, obtaining medical equipment, and physical therapy.

Is there any political impact on the financial support of these insurance types?

Like other healthcare insurance plans, the entire healthcare system partly impacts HMOtics. Politics drives policy changes that affect the overall mechanism of insurance plans (Brandon, 2017). These policies may require reductions in premiums, deductibles, and co-payments. This overall affects the working of these insurance plans.

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 References

Brandon, W. (2017). Politics, Health, and Health Care: Selected Essays. Journal Of Health Politics, Policy, And Law, 38(6), 1193-1199. https://doi.org/10.1215/03616878-2373287

Hayes, A., & Catalano, T. (2022). Health Maintenance Organization (HMO). Investopedia. Retrieved 6 March 2022, from https://www.investopedia.com/terms/h/hmo.asp.

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Complete this discussion in a 150 – 300 response.

Government Versus Private Funding

Explore the difference between the following:

Medicare, Medicaid, and private insurance of your choice (such as Major Medical, PPO, or HMO):

Respond to the list of questions below for each, supporting your answers with resources appropriate to the topic

1. Describe how this insurance is paid for. Who pays for it?

2. Who is eligible to have this insurance? Why?

3. How does the insurance work? (Co-payments, Deductibles, Premiums, Capitation, etc.?

4. Give an example of a healthcare service covered under this insurance type.? Evaluate how the service is paid for and what is needed for the individual to obtain the service.

5. Is there any political impact on the financial support of these insurance types?

Use your course and textbook readings and the South University Online Library to support your work. As in all assignments, cite your sources in your career and provide references for the citations in APA format.