Managed Health Care and Your Children:

Although many people are against managed care plans, they are a viable alternative to traditional insurance plans for those who cannot afford higher premiums. There are two main types of managed care plans from which to choose: HMO or a Health Maintenance Organization and a PPO, or a Preferred Provider Organization. Each one has different strong and weak points, as well as different benefits for policy holders.

Let's look at each type of plan and how it will affect the health care of your child.

HMO's

An HMO will require you to select a primary care physician from their network. If you do not visit this physician, the visit will not be covered by your insurance plan. In addition, you will have limited access to specialists, who must be in-network and referred by your primary care physician. The amount of preventative care in an HMO is lesser than a PPO. With a child, you will need to have coverage for at least one general check-up per year, as well as coverage for immunizations, and well-child check-ups.

This type of plan may not work for parents of children with specific care needs. Not all services will be covered and may require a lengthy approval process. Any parent who has had a sick child knows how painful this waiting process can be, and in the case of an emergency, it can be deadly.

However, the most attractive facet of an HMO is the reduced cost. If you simply cannot afford high premiums, co-pays and higher deductibles, this may be your only option.

PPO's

This type of plan generally has more freedom and will allow you to select your own primary care physician. The main benefit is the removal of the referral process if your child needs to see a specialist. Even if you do have to go out of network, at least some of the care is generally covered. This freedom means a lot to parents, particularly if their child needs additional health care.

Routine check-ups and immunizations are normally covered, but may be subject to co-pays and deductibles. Prescription drugs will also require a co-pay. Co-insurance is also common with PPO plans, which means that you will be responsible for a specific percentage of your child's health care, such as 20% while the insurance company will pay the other 80%.

If you are concerned about needing the freedom to see specialists or your child needs greater coverage, a PPO plan will be more suited to your needs.

No one likes to think about their child being sick. Unfortunately, this is something that all parents will need to consider and be prepared to face. Purchasing the right kind of health


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