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:

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.

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.

A 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.