Managed Care Insurance – What You Should Know

Posted in Health Insurance

February 10th, 2009

Managed care insurance plans are relatively common forms of health insurance coverage. Opposite of indemnity plans that ask you to pay for your service, after which you will be partially or fully reimbursed, managed care insurance plans contract with health care providers in order to offer members care at reduced costs.

3 Types of Plans

Managed care insurance plans come in three types: HMO, PPO, and POS. The HMO is also known as the Health Maintenance Organizations. They only pay for care within your network and allow members to choose a primary care doctor who coordinates the majority of your care. The PPO (Preferred Provider Organizations) pays for care in and out of the network, but more if you stay in. And POS allows you to choose between an HMO and PPO each time you get care.

The Goals of Managed Care Insurance

This type of healthcare insurance coverage has several goals in mind:

• To provide high-quality care in a way that costs can be managed or controlled.
• To make sure that the care is rendered by the most appropriate provider.
• To deliver care that is appropriate to the patients condition.
• To offer care in the least-restrictive setting.

Typically, the amount that a member will pay depends upon the rules of the network that member joins. If a plan is more restrictive, it will cost you less, and if its more flexible, it will cost more.

If managed care insurance is the type of health care insurance coverage you think you might want, its good to explore the available networks before committing. This way, you wont spend your money for services that dont fully satisfy your needs.