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Home Knowledge CenterWhat is Managed Care?
If you have a health plan, chances are you have a managed care plan.
The term “managed care” is used to describe a type of health care focused on helping to reduce costs, while keeping quality of care high. The most common health plans available today often include features of managed care. These include provider networks, provider oversight, prescription drug tiers, and more. These are designed to manage costs for everyone without sacrificing quality care. What is an example of a managed care plan?A good example of a managed care plan is a Health Maintenance Organization (HMO). HMOs closely manage your care. Your cost is lowest with an HMO. You are limited to seeing providers in a small local network, which also helps keep costs low. You are also required to have a Primary Care Provider (PCP) who coordinates all your care. There are a few other common health plans that fall into this category as well. What is a managed care organization?A managed care organization (MCO) is a health care company or a health plan that is focused on managed care as a model to limit costs, while keeping quality of care high.
The following are the most common characteristics included in many popular health insurance plans. These are examples of managed care:
What are types of managed care plans?Here are the basic types of managed care organizations or plans:
Learn more about HMOs, PPOs, and EPOs How does managed care work?The primary way in which managed care plans work is by establishing provider networks. A provider network serves plan members over a certain geographic area in which the health plan is available. The providers in these networks agree to offer their services at reduced costs. Your health plan pays more of the cost of your care if you see providers in the network. In fact, some plans will not cover you at all if you go to a doctor out-of-network. Are HMOs and PPOs managed care plans?Both HMOs and PPOs are examples of managed care plans. An HMO is much more limited in how you can use it, but it also offers you the lowest cost. For example, you must see doctors within the plan’s network to be covered—no flexibility. For a PPO, you have the option to see doctors outside the network and still be covered, but you will save money if you see in-network doctors. A PPO also costs a bit more than an HMO for that flexibility. Both types of plans are designed to help keep costs lower and quality high. Managed care is a type of health care model that is commonplace. Most common types of health plans have features of managed care that help keep costs in check and quality of care high.
Types of Health Insurance How Health Insurance Works What's the Difference Between an HMO, EPO, and PPO? Buying Health Insurance: How to Choose the Right Plan
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This information is for educational purposes only. It is not medical advice. Always consult your doctor for appropriate examinations, treatment, testing, and care recommendations. Cigna assumes no responsibility for any circumstances arising out of the use, misuse, interpretation or application of the information provided. |