Coordinated Care Plan

Coordinated Care Plan is a Medicare plan that uses a CMS-approved provider network to deliver covered healthcare services through coordinated care arrangements.

🧠 Full Definition

A Coordinated Care Plan is a type of Medicare health plan that operates through a CMS-approved network of healthcare providers contracted or arranged to deliver covered medical services to plan members.

These plans coordinate healthcare services through managed provider networks and typically include plan structures such as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Provider-Sponsored Organizations (PSOs).

Coordinated Care Plans are designed to manage healthcare delivery, improve care coordination, and administer Medicare benefits within structured network systems approved by CMS.

📌 Key Characteristics

• Uses a CMS-approved provider network
• Coordinates healthcare delivery through managed care systems
• Includes HMOs, PPOs, and PSOs
• Providers operate under contract or arrangement with the plan
• Delivers CMS-approved Medicare benefit packages

💡 Why It Matters

Understanding Coordinated Care Plans helps Medicare beneficiaries evaluate how provider networks, referrals, and managed care rules may affect healthcare access and costs.

These plans can affect:

• provider choice and network access
• referral and authorization requirements
• care coordination services
• out-of-pocket healthcare costs
• coverage flexibility for specialists and hospitals

🌐 MedicarePlans.com Perspective

Most Medicare Advantage plans operate as Coordinated Care Plans. Understanding whether a plan uses HMO, PPO, or other network structures can help beneficiaries choose coverage that matches their provider preferences and healthcare needs.

🗣️ Example Use

“The Coordinated Care Plan used a CMS-approved provider network to deliver Medicare-covered healthcare services to members.”

🔗 Related Terms

• Managed Care Plan
• Managed Care Plan with a Point-of-Service Option
• Health Maintenance Organizations (HMO)
• Point of Service (POS)

📚 Source Definition

Original definition sourced from the Centers for Medicare & Medicaid Services (CMS).

COORDINATED CARE PLAN: A plan that includes a CMS-approved network of providers that are under contract or arrangement with the M+C organization to deliver the benefit package approved by CMS. Coordinated care plans include plans offered by health maintenance organizations (HMOs), provider-sponsored organizations (PSOs), preferred provider organizations (PPOs), as well as other types of network plans (except network MSA plans. See 42 C.F.R. § 422.4(a)(1).