A managed care plan is a type of health insurance. Managed care plans have a network of health care providers and encourage their members to use providers within that network. Generally, the more flexible a plan is, the more expensive it will be. There are three categories of health insurance that are considered managed care plans:
Health Maintenance Organization (HMO) – HMO plans usually do not have deductibles. Instead, the plan will have set co-payments for different types of visits. An HMO will only cover medical services provided by in-network doctors and facilities. Additionally, you are required to choose a Primary Care Physician (PCP) who you must contact first for all medical concerns. Your PCP handles your overall medical care and can refer you to a specialist, if needed.
Preferred Provider Organization (PPO) – A PPO does not require that you designate a PCP and will cover medical care from out of network providers. With a PPO, you can expect to pay an annual deductible in addition to any co-payments. If you choose to receive care from a facility or doctor outside of the network, you will pay more than you would for in-network visits. Depending on your plan, you may need a referral to see an out of network specialist.
Point of Service (POS) – A POS is a hybrid of an HMO and a PPO. With a POS plan, you designate a Primary Care Physician but have the flexibility to visit out of network providers. If you do choose to see a provider out of network, you will pay more than you would for the same service from an in network provider. As with a PPO, most POS plans have a deductible and base the co-payment on a percentage of the visit.
Which is the Right Plan for You?
There is not one type of managed care plan that is right for everyone. HMOs generally cost the least out of pocket, but your provider options are limited. A PPO offers more flexibility, but you will spend more out of pocket. A POS allows you a little more flexibility than an HMO and will likely cost you a bit less than a PPO.
At Spickelmier Insurance, we help you determine which managed health care plan is right for you. Contact us today to let one of our highly experienced agents answer any questions you have and help you get started.