Health Care Options - Managed Care Health Insurance

Managed Care evolved as a means for controlling the skyrocketing healthcare costs under the traditional Fee-for-Service system. It is a health care system that is expressly designed to manage the delivery of health services in an efficient, cost-effective manner. Today, well over half of all Americans with health insurance coverage have a managed care health policy. It is also the most common health plan offered by employers.

The two leading Managed Care Organizations (MCOs are the Health Maintenance Organizations (HMOs) and the Preferred Provider Organizations (PPOs).

Health Maintenance Organizations (HMOs)
The term “health maintenance” derives from HMOs' emphasis on preventive care, which is based on the idea that keeping its members healthy, it will avoid more the costly medical expenses of a preventable condition. To this end, HMOs provide preventive care such as well-baby visits, mammograms, immunizations and physicals.

The HMO is both the insurer and the healthcare provider, with its own network of healthcare personnel and facilities. The HMO has its own hospitals and clinics, and either employs its own health care personnel, or contracts with a network of individual doctors and medical practices to deliver services

The HMOs are the most restrictive of the managed care plans, as they strictly limit your choices of benefits, procedures and healthcare providers. Your choice of doctors and hospitals, for example, is limited to its network of healthcare providers. If the required care requires a provider outside the network, express authorization from your primary care physician must be obtained prior to getting this service. Exceptions are made for emergency care.