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Your primary care doctor will serve as your regular doctor, managing your care and working with you to make most of the medical decisions about your care as a patient. In many plans, care by specialists is only paid for if your are referred by your primary care doctor.
An HMO or a POS plan will provide you with a list of
doctors from which you will choose your primary care doctor (usually a family
physician, internists, obstetrician-gynecologist, or pediatrician). This could
mean you might have to choose a new primary care doctor if your current one does
not belong to the plan.
PPOs allow members to use primary care doctors outside the PPO network (at a
higher cost). Indemnity plans allow any doctor to be used.
Where Do I Get These Health Plans?
Group Policies
You may be able to get group health coverage—either indemnity or managed
care—through your job or the job of a family member.
Many employers allow you to join or change health plans once a year during open
enrollment. But once you choose a plan, you must keep it for a year. Discuss
choices and limits with your employee benefits office.
Individual Policies
If you are self-employed or if your company does not offer group policies, you
may need to buy individual health insurance. Individual policies cost more than
group policies.
Some organizations—such as unions, professional associations, or social or civic
groups—offer health plans for members. You may want to talk to an insurance
broker, who can tell you more about the indemnity and managed care plans that
are available for individuals. Some States also provide insurance for very small
groups or the self-employed.
Medicare
Americans age 65 or older and people with certain disabilities can be covered
under Medicare, a Federal health insurance program.
In many parts of the country, people covered under Medicare now have a choice
between managed care and indemnity plans. They also can switch their plans for
any reason. However, they must officially tell the plan or the local Social
Security Office, and the change may not take effect for up to 30 days. Call your
local Social Security office or the State office on aging to find out what is
available in your area.
Medicaid
Medicaid covers some low-income people (especially children and pregnant women),
and disabled people. Medicaid is a joint Federal-State health insurance program
that is run by the States.
In some cases, States require people covered under Medicaid to join managed care
plans. Insurance plans and State regulations differ, so check with your State
Medicaid office to learn more.
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