What Is Managed Care?

“Managed care” is an approach to health insurance coverage that aims to maximize the quality of health care — and control costs.

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There are many kinds of managed care plans, and they all share one defining trait: the companies that offer them create provider networks of doctors, hospitals, and other health care specialists. The health care providers in these networks offer care at reduced prices, and in return get referral business from the health plan.

To keep costs low, managed care plans put restrictions on how their members receive care. For example, in HMO health plans members must receive their care from “in-network” providers. PPO health plans allow their members to see any provider, but offer more coverage when the provider is in-network.

Traditional insurance plans — often called FFS health plans — don’t have these networks. They simply cover specific medical services. You can receive those services from any provider you choose. Because of this, FFS plans tend to be much more expensive than managed care plans.

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