What is the Difference Between Managed Care and Traditional Health Insurance in Virginia?

There are a number of significant differences between managed care plans and traditional health insurance policies. You should consider these differences when deciding what type of plan best suits your needs.

Under Managed Care plans, your choice of providers may be limited to those within the network, or your out-of-pocket costs will be lower when you obtain services from providers within the network. Under a traditional health insurance policy, you may select your own providers.

Under some Managed Care plans, the provider receives a pre-established fee regardless of the amount of service performed. A provider may receive a flat fee for each patient in the plan, or he or she may receive a negotiated fee for each service performed. Under traditional health insurance plans, the provider bills you each time you receive care or treatment.

Under an HMO plan, you must live, work or reside within the plan's service area in order to be eligible for coverage. Under a traditional health insurance plan, you are covered regardless of where you live, work or reside.

Under Managed Care plans, normally a PCP manages your medical care, and, with some exceptions, you must receive a referral from your PCP in order to obtain the services of a specialist. Under a traditional health insurance plan, you do not have a PCP, and you do not need a referral to see a specialist.