Types of Managed Care

Health Maintenance Organization (HMO)

A managed care plan that requires a PCP and network providers. Referrals are needed for specialists. Lower costs with a focus on preventive care.

Traditional Insurance (Fee-for-Service, FFS)

Allows patients to see any provider without referrals or networks. Uses deductibles and coinsurance but has higher costs.

Preferred Provider Organization (PPO)

A plan that allows in- and out-of-network care without referrals. Lower costs in-network but higher premiums than HMOs.

Point of Service Plan (POS)

A hybrid of HMO and PPO. Requires a PCP and referrals, but allows out-of-network care at a higher cost.

Provider-sponsored organization (PSO)

A managed care plan owned by healthcare providers that offers coordinated care through its provider network.

Private Fee-for-Service (PFFS) Plan

A Medicare Advantage plan that allows any provider who accepts the plan's payment terms. No PCP or referrals required.

Medicare Medical Savings Account (MSA)

A Medicare Advantage plan with a high-deductible health plan and a medical savings account for healthcare expenses.

Exclusive Provider Organization (EPO)

A plan that only covers in-network care (except emergencies) but usually does not require specialist referrals.

Staff Model HMO

An HMO where providers are employed directly by the HMO and care is provided in HMO-owned facilities.

Group Model HMO

An HMO that contracts with one physician group to provide healthcare services.

Network Model HMO

An HMO that contracts with multiple physician groups, giving members more provider options.

Mixed Model HMO

An HMO that combines Staff, Group, and Network models to increase provider flexibility.

Direct Contract Model HMO

An HMO that contracts directly with individual physicians and hospitals instead of provider groups.

Full-service HMO

An HMO that provides a full range of healthcare services through its provider network.

Independent Practice Association (IPA)

An organization of independent physicians who contract with HMOs while maintaining their own private practices.