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What is managed care insurance

what is managed care insurance

Managed care plans fall into 3 basic types plans:




A common trait among managed care plans is the incentive (usually, a lower premium) for the insured to stay within a specified network of health care providers.

Health Maintenance Organizations (HMOs)

HMOs provide medical treatment on a prepaid basis, which means that HMO members pay a fixed monthly fee, regardless of how much medical care is needed in a time period (usually a monthly basis). In return for this fee, most HMOs provide a wide variety of medical services, from office visits to hospitalization and surgery. There are exceptions but most HMO members must receive their medical treatment from those within the network.

A PPO is made up of doctors and or hospitals that provide medical service only to a specific group. Rather than prepaying for medical care, PPO members pay for services as they are provided. The PPO sponsor (usually an employer

or insurance company) usually reimburses the member for the cost of the treatment, minus any co-payment fee. In some cases, the doctor may submit the bill directly to the insurance company for payment. The insurer then pays the covered amount directly to the health care provider, and the member pays his or her co-payment amount. The price for each type of service is negotiated in advance by the health care providers and the PPO sponsor(s).

Point Of Service (POS) plans

A point of service plan is a type of system where you pay no deductible and usually only a small co-payment when you use a health care provider within your network. You also must choose a primary care physician who is responsible for all referrals within the POS network. If you choose to go outside of the network for health care, you will likely be subject to a deductible, and your co-payment will be a percentage of the physicians charges.

Category: Insurance

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