Managed care plans are a type of health insurance. They have contracts with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan's network. How much of your care the plan will pay for depends on the network's rules.
Plans that restrict your choices usually cost you less. If you want a flexible plan, it will probably cost more. There are three types of managed care plans:
- Health Maintenance Organizations (HMO) usually only pay for care within the network. You choose a primary care doctor who coordinates most of your care.
- Preferred Provider Organizations (PPO) usually pay more if you get care within the network. They still pay part of the cost if you go outside the network.
- Point of Service (POS) plans let you choose between an HMO or a PPO each time you need care.
- Health Insurance: Understanding Your Health Plan's Rules (American Academy of Family Physicians) Available in Spanish
- Types of Managed Care Plans (American Academy of Pediatrics)
- Type of Plan and Provider Network (Affordable Care Act) (Centers for Medicare & Medicaid Services) Available in Spanish
Journal ArticlesReferences and abstracts from MEDLINE/PubMed (National Library of Medicine)
- Glossary of Managed Care Definitions (Patient Advocate Foundation)
- Medicaid and Managed Care: Key Data, Trends, and Issues (Henry J. Kaiser Family Foundation) - PDF
- Managed Care Plans: Getting Good Care for Your Child (American Academy of Pediatrics)
- Women's Preventive Services Guidelines Affordable Care Act Expands Prevention Coverage for Women's Health and Well-Being (Health Resources and Services Administration)
- Health Maintenance Organization (HMO) Plan (Centers for Medicare & Medicaid Services) Available in Spanish
- Medicare Advantage Plans (Centers for Medicare & Medicaid Services) Available in Spanish
- Medicare Special Needs Plan (SNP) (Centers for Medicare & Medicaid Services)
- Preferred Provider Organization (PPO) Plans (Centers for Medicare & Medicaid Services) Available in Spanish