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BenefitsNW.com a Website of Benefits NW, Inc.
WA Medical Insurance
Robert S. Mori, CPA, President
7429 East Heather Way, Everett, WA 98203-542424
Tel.(425) 353-9763 Toll-free (877) 455-7591 Greater Seattle (206) 965-9609
WA Medical Insurance
(Continued from WA Health Insurance)
Over time, different types of WA state medical insurance plans developed. Since the 1980's HMO's, PPO's and POS's and other hybrid types were created with differing levels of leverage and control over provider activities, different types of organizations and varying levels of elasticity over how and where medical care is provided in WA state. These plans delivered different organizational structures, and some more and some less flexibility over where and how care was delivered. Yet, most of these WA medical insurance plans continue to exist and can be found in various places today in WA state.
Initiated in the 1980's was a new type of managed care plan in WA state, and that was the preferred provider organization or what is commonly known as the PPO medical plan. this type of health plan rapidly became the most popular type of medical plan. Employers liked it over the traditional indemnity plans because they reigned in costs and were cheaper. Employees and families liked it because they could go to anyone on the PPO list and even choose specialists and see them without a referral. This eliminated the hassle of having to go to two appointments for one issue. In summary, the preferred provider organization provided more flexibility than the HMO. One could choose to stay within the preferred network or go outside and see any participating providers at a higher cost thru higher deductibles and co-insurance percentages.
As new plan designs came to the marketplace, the distinctions became more more fuzzy. The point-of-service (POS) is in effect an HMO plan with the ability to go outside the boundaries of the HMO and see providers who are not in the HMO network. This could be an adjoining PPO network or a list of participating providers. While PPO and point-of-service plans have grown in popularity over the past decade, HMO's have declined in popularity and usage here in WA State. Enrollment has grown in medical health insurance plans that are less restrictive and employers have backed away from HMO's for the same reason. Instead, employers are using higher deductible PPO plans for the most part to offset the increases in rates.
The issue of cost containment continues to occupy center stage at both the public and corporate policy levels. New ideas on how to structure benefits continue to be tried to keep costs under control with many attempts thrown out because they are found to be either impractical to use or they become offensive to the subscribers.
A few ideas become popular and start a new trend in the design of WA medical insurance lans. As a result of the many innovations, a new vocabulary has been created to articulate these new designs.
Bottom line, there are really only a few effective means of keeping costs under control in medical insurance plans. One method is to create incentives to limit the types and the quantity of procedures utilized to those found most cost-effective. Secondly is to limit the percentage of these costs that is paid for by the medical plan.
Control of the problem of health care costs and coverage is another major issue. There are increasingly insistent calls for action at both the federal and state levels and a growing number of business leaders have begun to lend their support to some form of national health insurance, though few believe that such a move will solve the cost problem.