The 9 Most Common Health Plans
Main Points
The most common health plans and what you need to know about them
The term "health plan" can be misleading, so we are hoping to define the term and outline the most common health plans and what you need to know about them.
First, a health plan, is a type of health insurance product offered by a company. Each plan is structured differently and serves a different purpose depending on who or what is signing up for that plan.
Therefore, when you hear the term "health plan", think what product is the health insurance company offering and what does that mean for me and my patients.
Common Health Plans
Flexible Spending Accounts (FSA) A Flexible Spending Account is an account that reimburses employees for specified expenses as expenses are incurred. The funding for FSAs is usually from the employees paychecks. These types of plans are common among young people that don't have a lot of healthcare expenses. The covered amounts and covered services are determined by the carrier of the FSA. Therefore, you will want to check the patients benefits before seeing them to see if they will be covered.
Health Maintenance Organization (HMO): An HMO is a type of health benefits plan where members are required to receive healthcare only from providers that are part of the HMO network. A common problem with HMO plans is that they are very exclusive. So, if you are out of network with this kind of plan it will be very difficult to get paid for your work. Likely your claims will take 60-120 days to process on average. The best course of action is to have the patient pay in full and submit a courteousy claim for the patient.
Health Savings Account (HSA): An HSA account is an account that reimburses you for specific healthcare expenses. The money contributed to your HSA belongs to you and can be used to cover eligible expenses. Funding for an HSA can come from the insurance company, employer, employee, or anyone else. Often patients will have a card similar to a credit card to pay for eligible expenses.
Medicare Medicare is a federally funded health insurance, typically for those aged 65 and over or for people under 65 who are disabled or who meet special criteria. At the time of this blog only psychologists and LCSWs can see medicare patients. If you fit into one of those categories, you will want to make sure you follow Medicare guidelines very closely as Medicare audits practices frequently.
Preferred Provider Organization (PPO): A PPO is a plan that allows members to choose any provider but offers higher levels of coverage if the member receive services from healthcare providers in the PPO network. This is one of the most common types of health plans because they are cost-effective to employers and employees, and offer great access to care.
Health Reimbursement Arrangements (HRA): An HRA is an account that reimburse employees for specific healthcare expenses as expenses are incurred. Funding is provided by employers. Even if you are in-network with the plan, you will likely see the payment go directly to the patient. Therefore, you will want to make sure you bill the patient for the expenses of the service before they leave your office, otherwise you might not see payment for those services.
Indemnity: This is also known as "traditional insurance" or fee-for-service. Indemnity is a traditional plan that reimburses for healthcare services provided to members based on providers' bills submitted after the service is rendered. These types of plans are common with Unions and other special groups and organizations.
Point of Service (POS): POS coverage is a healthcare option that allows members to choose medical services as needed and whether they will go to a provider within the network. These are common among people that don't want to pay a lot of money in premiums as this is a pay as you go option. The people with this kind of plan will be amenable to private pay and sliding scale opotions.
Medicaid: Medicaid is a joint federal and state program that provides hospital expense and medical coverage to low-income people and certain disabled individuals.
