Features of Private Payer and Consumer - Driven Health Plans
Mary Davis
HCR 230
September 20, 2015
Charlene Carpenter

Features of Private Payer and Consumer - Driven Health Plans

When it comes to health insurance plans there are many different private payers that include preferred provider organizations (PPO), health maintenance organizations (HMO), group health maintenance organizations, independent practice association (IPA), point of service (POS), Indemnity, and consumer-driven health plan (CDHP). And consumer-driven type accounts are health reimbursement accounts (HRA), and flexible savings accounts (FSA) (Valerius, Bayes, Newby, & Blochowiak, 2014).
Preferred Provider Organization PPO is one of three main types of managed-care plans. It is a fee-for service plan that contracts with medical care providers who provide services for discounted fees to enrollees. If these providers have contracted with the plans they are paid more, but if they have not contracted with the plans they are covered at a lesser payment rate ("The Private Health Insurance Market", 2015). Payment of a premium and sometimes copay for visits are required for PPOs. Primary care physicians are not required to oversee patient’s care for a PPO and referrals to specialist are not required. The premium and copay for a PPO plan is much higher compared to an HMO or POS plan. There are many in-network generalists and specialists for members to choose from. Generally, higher copays, and or increased deductibles are charged if members use out-of-network providers (Valerius, Bayes, Newby, & Blochowiak, 2014).
HMOs are a managed-care plan and they cover approximately 70 million people. They are licensed under special state laws that recognize that they tightly incorporate health insurance with provision of health care. They function like health care providers and insurers. There