Managed Care

Managed care plans are a type of health insurance. They have contracts with healthcare providers and medical facilities to provide care for members at reduced costs. These providers typically make up the plan's network. Your text lays out six models of managed care. We will further study four of the plans. Below, you will find several links you will need in order to complete this assignment:

• A chart that you will submit as your homework assignment.
• HMO plan
• PPO plan
• POS plan
• EPO plan

Correlate four of the six managed care models with their characteristics.
Include the following in your assignment:

• Describe the financial differences between the models.
• Which model provides the most flexibility for patients to select their providers?
• Which model would you select and why?

Sample Answer

Managed Care Plan Analysis

Managed care plans are a type of health insurance that contract with a network of providers to offer healthcare services at a reduced cost. Here is a breakdown of four common models:

Health Maintenance Organization (HMO): This plan requires members to choose a primary care physician (PCP) from within the network. This PCP acts as a "gatekeeper," coordinating all care and providing a referral to see a specialist.

Preferred Provider Organization (PPO): PPOs have a network of providers, but members are not required to have a PCP or get a referral to see a specialist. They can see out-of-network providers, but at a higher cost.

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