Managed Care

Health Maintenance Organization (HMO)

• Health insurance plan that allows you to see any doctor, anytime.  Usually has a copayment and is cheaper if you use in-network doctors.
• Health insurance plan that requires you to work with a primary care physician to manage you care.  Also  require you to use in-network services.
• Health insurance plan that combines elements of HMO and PPO. You can use a Primary Care Physician or direct your own care.

Preferred Provider Organization (PPO)

• Plan that requires you to work with a primary care physician who will direct your care.  Requires you to use in-network providers.
• Plan that combines elements of PPO and HMO.  You can use a primary care physician or direct your own care.
• Plan allows you to see any doctor at anytime.  Usually has a co-payment and is cheaper if you use in-network providers.

Managed Care

• Services designed to keep you healthy.Usually provided at no cost to the consumer.
• Health problem that existed before the date your insurance became effective.
• Way a healthcare system manages its costs and uses its resources.

managed care plans

• HMO
• PPO
• BOTH
• NONE

most expensive managed care plan

• HMO
• PPO
• BOTH
• NONE

employer sponsored

• HMO
• PPO
• BOTH
• NONE

requires patients to get referrals to see specialists

• HMO
• PPO
• BOTH
• NONE

provides much flexibility when choosing doctors

• HMO
• PPO
• BOTH
• NONE

least expensive managed care plan

• HMO
• PPO
• BOTH
• NONE

Managed Care

• Insurance plans designed specifically to control the cost of healthcare
• Also known as PPO
• Also known as HMO
• A referral to see a specialist