Managed care plans are health insurance plans that contract 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.
Restrictive plans generally cost you less. More flexible plans 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, but they still pay a portion if you go outside
- Point of Service (POS) plans let you choose between an HMO or a PPO each time you need care
- Managed Health Care Plans(American Heart Association) - http://www.americanheart.org/presenter.jhtml?identifier=4663
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Health Insurance: Understanding Your Health Plan's Rules(American Academy of Family Physicians) - http://familydoctor.org/online/famdocen/home/healthy/health-ins/734.printerview.html
Also available in Spanish http://familydoctor.org/online/famdoces/home/healthy/health-ins/734.printerview.html
- Consumer’s Checklist: How to Overturn Managed Care Treatment Denials(Mental Health America) - http://www1.nmha.org/consumer/denialfact.cfm
- Managed Care (and Emergency Services)(American College of Emergency Physicians) - http://www3.acep.org/patients.aspx?id=26094
- Managed Care and Your Mental Health(American Psychiatric Association) - http://healthyminds.org/managedcare.cfm
- The Public, Managed Care, and Consumer Protections(Henry J. Kaiser Family Foundation) - http://www.kff.org/spotlight/managedcare/
- Managed Care: Research Findings(Agency for Healthcare Research and Quality) - http://www.ahrq.gov/browse/managera.htm
References and abstracts from MEDLINE/PubMed (National Library of Medicine)
- Article: Local access to care programs (LACPs): new developments in the... - http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=18798886&tool=MedlinePlus
- Article: Computer-based documentation: effects on parent-provider communication during pediatric health maintenance... - http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=18762530&tool=MedlinePlus
- Article: Quality update. Working within the community. - http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=18714707&tool=MedlinePlus
- Managed Care -- see more articles - http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&term=(managed+care+programs[majr]+NOT+insurance,health[majr:noexp])+AND+english[la]+AND+humans[mh]+AND+(jsubsetk[text]+OR+review[pt]+OR+guideline[pt]+OR+patient+education+handout[pt]+OR+jsubsetaim[text]+OR+jsubsetn[text])+NOT+(letter[pt]+OR+editorial[pt])&doptcmdl=summary&cmd_current=Limits&pmfilter_EDatLimit=last+1+Year&tool=MedlinePlus
- Managed Care Terminology(Dept. of Health and Human Services) - http://aspe.os.dhhs.gov/progsys/forum/mcobib.htm
- State Health Insurance Counseling and Assistance Program (SHIPs)(Centers for Medicare & Medicaid Services) - http://www.medicare.gov/contacts/Static/SHIPs.asp
- Centers for Medicare & Medicaid Services - http://www.cms.hhs.gov/
- How to Use Your Managed Care Plan Effectively: Questions and Answers for Families with Children(American Academy of Pediatrics) - http://www.aap.org/family/mancarbr.htm
- Health Insurance - http://www.nlm.nih.gov/medlineplus/healthinsurance.html
- Health System - http://www.nlm.nih.gov/medlineplus/healthsystem.html