Managed Care is a term that is used to describe a health insurance plan or health care system that coordinates the provision, quality and cost of care for its enrolled members. In general, when you enroll in a managed care plan, you select a regular doctor, called a primary care practitioner (PCP), who will be responsible for coordinating your health care. Your PCP will refer you to specialists or other health care providers or procedures as necessary. It is usually required that you select health care providers from the managed care plan’s network of professionals and hospitals. There are many different types of publicly-funded managed care programs in New York State serving residents in all age groups and various income levels.
Managed care plans pay the health care providers directly, so enrollees do not have to pay out-of-pocket for covered services or submit claim forms for care received from the plan’s network of doctors. However, managed care plans can require co-pays paid directly to the provider at the time of service.
There are many different types of managed care plans. Most managed care plans certified by the New York State Department of Health offer health education classes or other programs to help enrollees stay healthy. Depending on the type of managed care plan you join, there may be additional services, such as transportation, available to you.