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Managed Care Plan Directory - New York State Department of Health

Managed Care Plan Directory - New York State Department of Health 2025

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The document is a guide for New York Medicaid consumers outlining the process of choosing a health plan within 60 days. It explains that most Medicaid recipients must select a health plan while retaining their regular benefits, provides instructions on how to choose a plan and doctor, details the services offered by health plans, and outlines consumer rights and options for those who may be exempt from joining a health plan.

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What do you mean by managed care?

Health Maintenance Organizations (HMO) usually only pay for care within the network. You choose a primary care doctor who coordinates most of your care. Preferred Provider Organizations (PPO) usually pay more if you get care within the network. They still pay part of the cost if you go outside the network.

What is the managed care plan ID?

A unique number, assigned by the state, which represents the health plan under which the non-fee-for-service encounter was provided including through the state plan and a waiver.

What is the difference between managed care and PPO?

The two main delivery system models are fee-for-service, where the Medicaid agency directly pays providers or groups of providers, and capitated managed care, where the Medicaid agency pays an external managed care organization, who then pays providers for covered services.

What is NY managed care?

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 plans network of doctors. However, managed care plans can require co-pays paid directly to the provider at the time of service.

What is NY Medicaid managed care?

Medicaid Managed Care offers many New Yorkers a chance to choose a Medicaid health plan. Managed Care plans focus on preventive health care and provide enrollees with a medical home for themselves and their families.

What is the difference between straight Medicaid and managed care?

In regular or fee-for-service Medicaid, beneficiaries would go to any doctor who accepts Medicaid. In managed care, the plan is paid a capitated rate (flat monthly fee) to provide for almost all of the beneficiarys health care needs.

How many Medicaid managed care plans are there in New York?

New York contracts with nearly 30 health plans, many of which participate in more than one program. Participating plans include a mix of: (1) four national, for-profit plans (Aetna, Amerigroup, United, and WellCare), (2) three local, for profit and (3) twenty five local, non-profit plans.

Managed Care Plan Directory - New York State Department of Health 2025

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