Affordable Health Plans

Written by Jeremy Horelick
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If there's one thing that doctors, patients, employers, and plan administrators can all agree on concerning affordable health plans, it's that they're growing increasingly difficult to find. Presently, some 45 million Americans are without any sort of health care coverage, a figure that represents roughly 15 percent of the population. These Americans aren't without excellent health care; they're without even the most basic protection.

Consequently, these 45 million Americans would be financially wiped out by even a short hospital stay or routine surgery. While there are pro bono organizations that can help alleviate some of this debt, the financial obligation still falls squarely on the shoulders of the care recipients, regardless of their socio-economic status or ability to pay. The alternative, however, is often much worse; neglecting a serious medical condition can lead to more debilitating problems or even death.

The Need for Reform

Most sane individuals agree that some measure of health care reform is needed in the U.S. and soon. With the so-called "baby boom" generation fast approaching retirement age, the need for better health care funding is more urgent than ever. The problem, however, is that health care reform isn't a politically friendly topic for candidates, for it comes with a hefty price tag.

Free-market advocates insist that it's not the government's job to ensure its citizens' health needs. Punishing drug companies and doctors, they argue, only decreases competition for lifesaving drugs and pushes the best medical minds away from the field of medicine. While many in this camp hold extreme views, there are plenty of others who support a two-tier system in which public assistance programs and private insurers work alongside one another. Regardless of which system rises to the fore, one thing is certain: managed care is here to stay.

Managed Care

Managed care offers those who can't afford private insurance a way of defraying some of their costs while still receiving medical care. HMOs (health maintenance organizations) were the first major players on the managed care scene, giving patients access to doctors and other caregivers at a specific location. While the cost of this care was (and still is) minimal, patients were (and are) assigned to chosen practitioners, be they primary care physicians or specialists.

Sometime later, PPOs (preferred provider networks) joined HMOs on the managed care menu with one distinguishing trait: freedom of choice. While PPO plan members cannot choose any doctor they want and still have their treatment fully covered, they can choose from an expansive network of generalists and specialists, not only in their home cities and states, but often across the entire United States (depending on the PPO in question). In return, members assume a larger share, usually a fixed percentage, of the allowable cost of their care.

Choosing Your Own Affordable Health Plan

In addition to HMOs and PPOs, a number of other competing health care products have entered the fray. Many consumers purchase supplemental insurance to bridge any gaps left by their primary plans such as exclusions, benefit limitations, and so forth. Still others shy away from insurance altogether and prefer to purchase access plans that provide standard discounts on all preventive care and treatment.

For those considering such a plan, consider that fee-for-services structures take many of the headaches out of choosing, receiving, and paying for care. There are no claim forms to file, no reimbursement requests, and no waiting periods. Better still, you know exactly how much your care will cost you before it's rendered, so there are no surprises later.


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