Medicaid Managed Care vs. Fee-for-Service: How Your Coverage Actually Works
Watch on YouTube About seventy-two percent of Medicaid enrollees get their care through a private insurance company, not the state directly. This episode explains the difference between managed care and fee-for-service Medicaid, why it matters for finding doctors, getting referrals, and filing complaints when your plan denies care. Covers the five largest Medicaid managed care companies, how capitation works, provider network traps, how to switch plans, and the real trade-offs between coordination and choice. Watch the next video in the playlist to learn how income limits work by category.
▶ Watch next: Medicaid Income Limits by Category: What You Can Earn and Still Qualify https://www.youtube.com/watch?v=W6WbBqjzJXs
📺 Full playlist: Medicaid (US - 2026) https://www.youtube.com/playlist?list=PLlIAFxS29649JfKT2uWUj5JKZqmduWdyo
Chapters
- 0:00 Most Medicaid Enrollees Are in a Private Plan
- 2:29 Fee-for-Service: The Original Medicaid Model
- 3:44 Managed Care: How Capitation and Networks Work
- 5:37 The Five Largest Managed Care Companies
- 7:28 Finding Doctors, Getting Referrals, and Switching Plans
- 9:06 When Your Plan Denies Care: Grievances and Appeals
- 11:14 Quiz Time
About 72% of Medicaid enrollees are in managed care plans — meaning a private insurance company (like UnitedHealthcare, Centene, Molina, or Anthem) administers their Medicaid benefits under contract with the state. The rest are in traditional fee-for-service, where the state pays providers directly. Most enrollees do not choose which model they get; the state assigns them. This episode explains both models, what managed care means for finding doctors, getting referrals, and filing complaints, and why it matters whether your state uses managed care or fee-for-service.
Key Topics
- Fee-for-service (FFS): the state pays providers directly for each service — the original Medicaid model
- Managed care: the state pays a private insurer a fixed monthly amount per enrollee (capitation), and the insurer manages care
- Forty-two states plus DC use comprehensive managed care for at least some Medicaid enrollees
- The five largest Medicaid managed care companies and their market share
- Provider networks: why your doctor may accept Medicaid FFS but not your managed care plan (or vice versa)
- How to pick a plan, change plans, and file a grievance if your managed care plan denies care
- The pros and cons: managed care can coordinate care better but may restrict provider choice; FFS offers more provider flexibility but less care coordination