In the pantheon of health insurance systems, there are a wide variety of options available to the American citizen. Both private and public health coverage allows for a comprehensive health plan to be acquired in whatever way one deems appropriate. In this essay, we will compare a managed care organization and a commercial health insurance company – how they work, how they compare, and what they can offer their customers. The managed care company will be Medicare, and the commercial insurance company explored is the health branch of American Family Insurance.
American Family Insurance works by providing commercial health insurance to the individual, based on several different types of coverage. First, there is a basic plan, which includes a low deductible (often around $250), maximums for out-of-pocket expenses, and monthly premiums based on factors such as age and income. These plans are most often used for basic maintenance and minor health concerns, such as checkups, tests, and the like. A high-deductible plan is only really used for catastrophic coverage; this does not cover the same procedures and checkups as a basic plan, but instead covers surgeries and major medical operations (“Health Insurance,” 2011). Finally, a comprehensive plan melds the two together, providing both basic and catastrophic coverage and giving the patient as much medical care as possible.
In working with American Family Insurance, you work with network providers, which are a conglomerate of physicians and hospitals that can take American Family health coverage. You must go to these hospitals in order to get easy access to your insurance. In the event of you needing to use your health insurance, filing a claim will only be successful if you go to the hospitals or physicians in their network.
Medicare, on the other hand, works to assist people of the age of 65 or older with these health services. They help to cover hospital outpatient care, home health care, and doctor’s services. They can also provide preventative services in order to maintain illnesses and keep your health in check (“Long Term Care,” 2009).
A gatekeeper system works by having a primary care physician assigned to a patient in a managed care system such as Medicare. This gatekeeper is part of the network established by the company, and is contacted before getting health care in order to save money, as they do not charge as much (Carlson, 2009). American Family Insurance, with its existing network of primary care physicians, uses this system to lower costs to their clients.
In terms of American Family Insurance’s relationship with Medicare, it provides Medicare Supplement Plans on top of their ordinary health insurance to those who qualify. It helps to fill in the gaps for those benefits and outpatient services that regular Medicare cannot completely cover. In order to pay for the rest of it, a Medicare Supplement Plan must be reached (“Health Insurance,” 2011).
These two health organizations – Medicare and American Family Insurance – work together to offer a more comprehensive and beneficial web of health care coverage, providing help with the needs of patients of all ages. The network of providers allows for lower costs (for a few services at least) and the variety of coverage types offered by American Family give people with any budget some sort of health care option.
References
Carlson, G. (2009, May 5). What is a Gate Keeper? . MissouriFamilies.org Home. Retrieved May 16, 2011, from http://missourifamilies.org/features/healtharticles/health44.htm
Health Insurance. (2011). American Family Insurance. Retrieved May 16, 2011, from http://www.amfam.com/products/health/default.asp
Long-Term Care. (2009, March 25). Medicare. Retrieved May 16, 2011, from www.medicare.gov/LongTermCare/Static/Home.asp
