Understanding Managed Care Organizations & Plans in Kansas & Missouri

At All Service Home Healthcare, we have the knowledge and experience to help our clients navigate the complicated healthcare options of Kansas and Missouri. We guide our clients to help them better understand the different types of Managed Care Organizations (MCOs) and managed care plans that they offer for eligible residents.

These programs provide quality healthcare services while controlling costs and ensuring efficient management for individuals who qualify.

This ASHH article will explore the main types of managed care plans:
• Health Maintenance Organizations (HMOs)
• Preferred Provider Organizations (PPOs)
• Point of Service (POSs)
• Exclusive Provider Organizations (EPOs)

Health Maintenance Organization (HMO)

Health Maintenance Organizations or HMOs emphasize preventative care and require eligible members to select a primary care physician or PCP. Once a PCP has been selected, they are responsible for coordinating the necessary healthcare services for an individual as well as providing referrals to specialists within the HMO network.

What Should You Consider When Choosing to Enroll Yourself or a Loved One for an HMO Plan?

• Network Restrictions: Qualified members living in Kansas and Missouri must use healthcare providers within the HMO network for services to be covered.
• Medical Referrals Required: For individuals with an HMO, we will require a referral from their primary care physician to access care from specialists and, typically, any other health-related services.
• Lower Out-of-Pocket Costs: If you or your loved one are qualified for an HMO, you will generally benefit from lower premiums and out-of-pocket expenses compared to other healthcare plans.
• Preventive Care Focus: HMOs focus on preventive services designed to maintain health and avoid higher costs associated with treating diseases later.

Below Are Some of the More Common HMO Plans That All Service Home Healthcare Can Assist Clients with, in the State of Kansas or Missouri:

• Kansas: Blue Cross and Blue Shield of Kansas, and Aetna both offer HMO options to eligible Kansas residents.
• Missouri: Anthem Blue Cross Blue Shield and UnitedHealthcare offer HMO plans for eligible Missouri residents.

Preferred Provider Organization (PPO)

Preferred Provider Organizations, also known as PPOs, offer greater flexibility in choosing healthcare providers and do not require referrals for specialists. Individuals who qualify for a PPO plan can see any healthcare provider but will save more by using providers within their PPO network.

What Should You Consider When Choosing to Enroll Yourself or a Loved One for a PPO Plan

• Flexible To Choose a Provider: Individuals who are enrolled and eligible for a PPO plan may see any doctor or specialist without a referral, both in-network and out-of-network.
• Higher Premiums: One downside to a Preferred Provider Plan is that it typically has higher premiums and out-of-pocket costs compared to other managed care plans, like HMOs.
• Out-of-Network Health Coverage: Eligible PPO members have health coverage for out-of-network services, though it will come at a higher cost.
• Direct Specialist Access: With a PPO plan, primary care physicians are not required to make the necessary referrals to see specialists.

Below Are Some of the More Common PPO Plans That All Service Home Healthcare Can Assist Clients with, in the State of Kansas or Missouri:

• Kansas: Blue Cross Blue Shield, Cigna, and Aetna of Kansas offer PPO plans for Kansas residents.
• Missouri: Anthem, Blue Cross and Blue Shield, Humana, and UnitedHealthcare offer PPO options for Missouri residents.

Point of Service (POS)

Point of Service or POS plans are interesting because they combine elements of both HMO and PPO plans. Like an HMO, Eligible POS plan recipients must choose a primary care physician and need referrals to see specialists, but they have the flexibility to seek out-of-network care at higher costs, like a PPO plan.

What You Need to Know When Choosing to Enroll Yourself or a Loved One for a POS Plan

• Primary Care Coordination: Like HMOs, members need to select a PCP who manages their overall care and provides referrals to specialists.
• Out-of-Network Flexibility: Like a PPO plan eligible members are permitted to see out-of-network providers but will pay higher out-of-pocket costs.
• A Balanced Cost Structure: POS plans usually have moderate premiums and out-of-pocket costs, balancing the features of HMOs and PPOs.
• Primary Care Physicians Referrals: Specialist visits and other medical services often require a referral from the PCP.

Below Are Some of the More Common POS Plans That All Service Home Healthcare Can Assist Clients with, in the State of Kansas or Missouri:

• Kansas: Aetna, and Blue Cross and Blue Shield of Kansas both offer Point of Service plans to eligible residents.
• Missouri: UnitedHealthcare and Anthem Blue Cross Blue Shield both offer POS options for Missouri residents.

Exclusive Provider Organization (EPO)

Exclusive Provider Organizations, commonly referred to as EPOs, are like HMOs but with more flexibility in choosing specialists within the network. Exclusive Provider Organizations allow their eligible members to use network providers for coverage except in emergencies.

What You Need to Know When Choosing to Enroll Yourself or a Loved One for an EPO Plan

• Network Restriction: When enrolled in an Exclusive Provider Organization, a member must use in-network providers for all non-emergency care.
• No Referrals Needed: Eligible EPO plan members are permitted to see specialists within the network without needing referrals.
• Lower Cost of Premiums: EPO plans often have lower premiums and out-of-pocket costs compared to PPOs.
• Streamlined Healthcare: EPO plans to focus on coordinated care within the network to help keep costs down.

Below you Will Find the EPO Plans That All Service Home Healthcare Can Assist Clients with, in the State of Kansas or Missouri:

• Kansas: Blue Cross and Blue Shield of Kansas, as well as Aetna, offer EPO plans to eligible residents of Kansas.
• Missouri: Providers such as Anthem Blue Cross Blue Shield and Cigna have EPO options for eligible Missouri residents.

Choosing the Right Plan with All Service Home Healthcare

Selecting the right managed care plan depends on the individual healthcare needs, budget, and preferences of each client.
Here are some of the ways that ASHH can help you make the most informed decision:

• Help Evaluate Healthcare Needs: Our team of healthcare experts will help you and your loved one consider the frequency of doctor visits, needs for specialists, and any ongoing medical conditions, as we determine the best option for you or your loved one.
• Budget Considerations: At ASHH we help every client compare premiums, out-of-pocket costs, and overall coverage to find a plan that fits their financial situation.
• ASHH Will Listen to Your Provider Preferences: Decide if having the freedom to choose any provider or specialist is important or if you prefer the cost savings of staying within a network. Then, let ASHH help you weigh the pros and cons of your plan options.
• Explain All Your Benefits: At ASHH, we discuss the additional benefits of a managed care plan, such as wellness programs, telemedicine options, and preventative care services.

In Kansas and Missouri, various MCOs offer a range of HMO, PPO, POS, and EPO plans tailored to meet diverse healthcare needs. By understanding the key features and differences of these plans, you can make informed decisions to ensure you receive the best care possible while managing healthcare costs effectively.

For more detailed information on specific plans available in your area, consult with All Services Home Healthcare or a local insurance broker who can provide personalized advice and assistance.

Missouri’s Consumer Directed Services – Learn More
Kansas’s Managed Care Program – Learn More

We can help you determine if you’re eligible for Kansas or Missouri financial and medical assistance, file paperwork, and navigate these complicated state benefits. To get started, call 913-814-3709 or schedule a Free Consultation Online.