Managed Care

What is Managed Care?

Managed care is a coordinated approach to providing necessary health services with an ultimate goal of low cost, quality care. It includes many different kinds of health insurance and health care plans; the basic types are HMOs, PPOs, and POS plans.

Health Maintenance Organization (HMO) is a health care plan, not just an insurance program. It organizes, controls, pays for, and provides almost every aspect of health care that a member may need. It gives you a list of doctors from which to choose a primary care doctor.

Preferred Provider Organization (PPO) is a system in which a payer negotiates lower prices with certain doctors and hospitals. It is closest to an indemnity plan (fee for service plan). It encourages you to use physicians, hospitals, and other health care providers that are part of a preselected network.

Point-of-Service (POS) is a plan that can preserve your freedom of choice. It usually costs more than HMOs and PPOs, but you can use doctors not in the plan without permission of your primary care doctor.

Managed Care References