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Department of Managed
Care and Clinical Business Plan Development
Vice President: Grace Wong
What is Managed Care and how does managed care work?
 Managed
Care is how medical services are provided to you and paid to your
provider. With most managed care plans, you usually have to go
to one of the doctors on the health plan's list. Many managed
care health plans require you to chose a "primary care provider."
Your Primary Care Provider (PCP) is the person who will "manage"
your health care needs. This person could be a pediatrician, general
practitioner, internist, and in some cases, an obstetrician/gynecologist.
In an emergency, you should call 911 or go to the nearest emergency
room.
Are there different kinds of managed
care plans?
 The
most common types of managed care plans are Health Maintenance
Organizations (HMO), Prefferred Provider Organizations (PPOs),
and Point of Service (POS). HMOs are the strickest form of managed
care plans. If you do not use in-network providers, your benefits
will not be covered. For POS and PPO plans, you can go out of
network but with higher out-of-pocket costs.
I am uninsured. How can I get
coverage for me and my family?
New York State offers several programs that may meet
the needs of your family: Child Health Plus (CHP), Family Health
Plus (FHP) and Healthy NY.
o Child Health Plus is available to all children under the age
of 19 who are uninsured or underinsured, regardless of their immigration
status.
o Family Health Plus is available to all legal residents of New
York State between the ages of 19-64 who do not have health insurance,
but who have incomes which are too high to qualify for Medicaid.
FHP provides comprehensive services with minimum co-payments to
its members.
o Healthy N.Y. is available for employers who have 50 or fewer
employees, working uninsured individuals, and sole proprietors.
Healthy N.Y. members have co-payments and deductibles.
Are there Medicare Managed Care Plans?
Yes, Medicare does provide a managed care option for members enrolled
in both Medicare Part A and B called Medicare Advantage Plans
or Medicare C. For Medicare Advantage Plans in your area call
1-800-MEDICARE or call the Managed Care office at SUNY Downstate.
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