When selecting a managed health plan, you may want to consider the following questions.

• Do you need a plan that covers preventive care?
• Are there pre-existing conditions that might limit your options?
• Do you want to stay with your current doctor? Ask to see the provider panel.
• At which hospital do you prefer to receive your care?
• Are the premium costs acceptable to you?
• Will the plan provide coverage if you change jobs or relocate to another city?
• Are you likely to need physical therapy, home care or other services, treatments or therapies? And, are these listed as benefits in the managed care plan?
• Maybe you are thinking about having a baby. Will the plan cover the costs for prenatal visits and delivery?

Managed Care refers to a broad and constantly changing array of health plans that attempt to manage the cost and quality of care. The two most common managed health care plans in Wayne County are Preferred Provider Organizations (PPO) and Health Maintenance Organizations (HMO). Another option is what is commonly called traditional, indemnity or fee-for service insurance.

HMOs have an emphasis on prevention and offer a select choice of doctors and hospitals. You select a primary care physician who coordinates all of your medical care, including referrals to a specialist and hospital care if necessary. You may also have minimal co-payments for office visits and other services. An HMO option is easier on your budget since you have minimal out-of-pocket and unexpected expenses as long as you receive all medical care through the HMO.

PPOs offer a select choice of doctors and hospitals. You may opt to use a PPO doctor and receive maximum reimbursement and benefits, or seek medical care from doctors and hospitals not in the PPO, and receive reduced reimbursement and benefits.

Traditional or indemnity insurance may not cover preventive service and you may see any doctor or hospital. You would pay an up front deductible before there is any reimbursement by the insurance company; and, you'll probably will be required to complete the claims paperwork. Traditional or indemnity insurance is the most expensive option for health plan coverage.

Consider your options carefully before choosing a health plan. Select one that best meets your needs. Most importantly, make sure the managed health plan gives you access to Wooster Community Hospital for the best medical care.

Co-Insurance: The amount paid out of pocket by plan members for medical services. The payment usually constitutes a fixed percentage of the total cost of a medical service covered by the plan. For example, if a plan pay 80% of a health bill, the patient pays the remaining 20%.

Co-Payment: A flat fee paid out of pocket for medical services. For example, a $5 or $10 co-payment (co-pay) may be required for each office visit, prescription, allergy shot, etc.

Deductible: The sum of money that an individual must pay out of pocket for medical services that the health plans pays their portion. Deductibles are usually per person, or per family, per calendar year.

Gatekeeper Physician (Primary Care Physician): This physician coordinates and manages the medical care of HMO patients. The primary care physician is usually a family physician, general internal physician or a pediatrician. This doctor sees the HMO patient for all medical services, refers the patient to a specialist when necessary and coordinates all hospital and other medical care.

Medicaid: The federal state health insurance program for low-income individuals, the indigent and elderly.

Medicare: The federal health insurance program for older Americans and eligible disabled individuals. Medicare HMOs are offered in Wayne County.

Preventive Care: An approach to health care which emphasizes preventive measures and health screenings such as routine physicals, well-baby care, immunizations, diagnostic lab and x-ray tests, pap smears, mammogram's and other early detection testing. The purpose of offering coverage for preventive care is to diagnose a problem early, when it is less costly to treat, rather than later in the stage of a disease when it is much more expensive, or too late to treat.

Primary Care Physician: These specialized physicians prove a full range of health care services to individuals. Family practice physicians, general internal medicine physicians and pediatricians are recognized by managed health plans as primary care physicians. Some HMOs recognize obstetrician/gynecologists as primary care physicians.