Benefits of the Sharp Health Plan
Navigating the tricky world of health insurance can be overwhelming for many people. Without guidance to understand your needs — and how to best get coverage for them — healthcare can be quite confusing.
But things just got a bit easier. Sharp Health Plan, a nonprofit commercial insurance carrier based in San Diego, is an option for individuals who don’t require complex medical care but want to have all their bases covered. Established in 1992, the Sharp Health Plan is an HMO with a Medicare contract.
Understanding HMOs
HMOs, or health maintenance organizations, have their own network of healthcare providers, hospitals, and doctors. These entities within the HMO are contracted to accept payments from patients at a certain level for their services. These agreements allow HMOs to keep costs regulated for their members. Two defining features of an HMO are the cost and choice of providers.
HMOs Can Offer Lower Costs
Because of the contracted payment level, HMOs typically offer lower monthly premiums than other types of insurance. They also offer lower co-insurance and co-pays, making them cost-effective and affordable. HMOs strictly do not cover any out-of-network care. The only exception is in the case of a legitimate emergency.
Choice of Providers
When signing up for an HMO, the process begins with selecting an in-network primary care physician, commonly known as a PCP. This doctor handles patient needs whenever they’re seeking medical care. The PCP also practices general medicine and coordinates any additional care a patient may require. If they require a specialist, the first step is for the patient to consult with their PCP. If specialist care is, in fact, warranted, the PCP will provide a referral to a specialist within the patient’s HMO network.
Medicare Contracts
The Medicare contract aspect means the Sharp Health Plan is a Medicare Advantage plan. This indicates more services may be covered under the HMO than strictly medical care. In some cases, a Medicare contract may cover:
- Prescription drugs
- Fitness programs
- Vision, hearing, or dental services
- Transportation to doctor visits
- Services that promote general health and wellness
These covered services and the associated rules are subject to change annually.
Medicare Advantage Plans vs. Original Medicare
Original Medicare covers hospital insurance and medical insurance. Meantime, Medicare Advantage, or Part C, is a bundled plan that covers not only hospital and medical insurance but also prescription drugs. Like an HMO, patients are limited to the healthcare providers within their network. Original Medicare is a government program, while Medicare Advantage plans are offered through private insurance companies.
Open Enrollment in Medicare
Each year during open enrollment, individuals with Medicare can amend their coverage for the coming year. Since Medical Advantage plans cover various services, beneficiaries may determine during open enrollment that they would prefer to add more wellness services to their plans to promote overall health. This period is also an opportunity to eliminate services that are no longer useful.
The Benefits of the Sharp Health Plan Are Numerous
The Sharp Health Plan is an excellent option for individuals not looking for complex medical care. For those who require maintenance care (annual physicals, dental cleanings, etc.), the Sharp Health Plan is beneficial and the most cost-effective option.
