Managed Care

In traditional health coverage plans the covered individual is generally allowed to receive services from the provider of their choice.  In managed care plans the covered individual is generally required to use a defined network of doctors and other providers.  In return for 'staying in the network,' the covered individual typically pays less for health care than if they went outside the network.

Types of Managed Care Plans

• Health Maintenance Organizations (HMOs). In HMO's, covered individuals pay a fixed dollar amount per month in return for access to a wide range of healthcare services.   Covered individuals have to select a primary care physician (PCP) from a defined network of providers.  The PCP manages their healthcare and gives prior approval for many services.
  

• Point of Service (POS) Plans.  POS Plans operate like an HMO except they offer HMO enrollees the option of receiving certain services outside the HMO's network.  The covered individual typically pays more out of their own pocket for going out of network.
  

• Preferred Provider Organizations (PPOs).  PPOs are managed care health plans that give covered individuals the choice to choose an 'in-network' provider or not.  But, the covered individual may have to pay more for going 'out of network.'
  

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