What is managed care?

You have a lot of options when it comes to shopping for health insurance. One of the most popular choices in California today is the managed care plan. Managed care plans take a unique approach to health care by contracting with health care providers and standardizing a certain level of care in order to control their costs as well as their members’ costs.

These plans tend to encourage their members to seek care from within their network of approved providers. In some cases, members may not be covered if they go outside the network, or their coverage level may be reduced when services are rendered by out-of-network providers.

Managed care plans include group health insurance options such as HMOs, PPOs, and POS plans. HMOs are health maintenance organizations. An HMO will often require that you use a primary care physician, or PCP, to coordinate your health care. Your PCP will provide basic care as well as the necessary referrals for any other health care you may need.

PPOs are preferred provider organizations. You will be able to seek care within the network of providers or outside the network, but care outside your network may be covered at a lower rate. You will also be able to self-refer to specialists, unlike with HMOs.

POS plans have some characteristics of HMOs and PPOs. You may be able to see both in-network and out-of-network providers. You may also be required to use a primary care physician and have authorized referrals prior to seeking specialist care or for hospitalization.

Managed care health coverage can be an affordable solution for your group or individual health insurance needs. Because each plan can vary widely in its benefits, it is crucial that you understand the terms of each plan before you choose the one that best meets your or your family’s health care needs.

 

Source: Health Care Los Angeles

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