Managed Health Care Plans Explained
Which type of health insurance plan is not considered a managed care plan?
A) preferred provider organization (PPO)
B) traditional
C) health maintenance organization (HMO)
D) point of service (POS) plan
Answer: Traditional
Answer: Traditional is not considered a managed care plan
Traditional health insurance plans, also known as fee-for-service plans, are not considered managed care plans. Managed health care plans involve contracts with health providers to offer care to members at a discounted rate. These plans typically have a network of providers and specific rules that members must follow.
There are three main types of managed health care plans:
1. Preferred Provider Organization (PPO)A PPO plan allows members to choose their healthcare providers, both in and out of network. Members have the flexibility to see specialists without a referral, but may pay higher out-of-pocket costs for out-of-network care.
2. Health Maintenance Organization (HMO)HMO plans require members to select a primary care physician (PCP) from a network of providers. Referrals from the PCP are needed to see specialists. These plans offer comprehensive coverage but have limited provider choices.
3. Point Of Service (POS) planA POS plan combines elements of HMO and PPO plans. Members choose a primary care physician and need referrals for specialists within the network, but can see out-of-network providers at a higher cost.
Managed health care plans aim to provide quality care at lower costs by negotiating rates with providers. Traditional fee-for-service plans do not have these negotiated rates and may only cover a portion of healthcare expenses.