Apple Health coverage without managed care

What is Apple Health coverage without a managed care plan?

Apple Health coverage without a managed care plan (also known as fee-for-service) is when Apple Health pays your provider directly. You may choose any provider who participates in the Apple Health fee-for-service program and currently accepts patients. View services covered under Apple Health.

Most individuals are enrolled in Apple Health managed care through a managed care organization (MCO). This means that the MCO serves as your single point of contact to get services and helps coordinate your care. Individuals enrolled in managed care must see providers who are in their plan's provider network, unless prior authorized or to treat urgent or emergent care.​

What is fee-for-service?

Apple Health pays your provider directly for some benefits even if you are enrolled in managed care, this is also known as fee-for-service.

The following services are always covered fee-for-service using your ProviderOne services card:

• Dental care.
• Eyeglasses and fitting services for children (under age 21).
• Long-term services and support.
• Services for individuals with developmental disabilities.
• Maternity support services, prenatal genetic counseling, and pregnancy termination.
• Inpatient psychiatric care.

Do I have to enroll in managed care?

Most clients are automatically enrolled into managed care and can choose which plan best fits their needs. For some situations you can receive health care without enrolling in a health plan.

American Indians or Alaska Natives options

If you are an American Indian or Alaska Native you will be automatically enrolled in Apple Health coverage without a managed care plan. You have the option to opt into a managed care plan. Read more on the American Indians and Alaska Natives webpage or call 1-800-562-3022.

Foster Care and Adoption Support

Foster Care and Adoption Support (FCAS) clients have the ability to opt out of managed care for their physical health coverage with a phone call to the FCAS team at 1-800-562-3022 ext. 15480.

If you decide to receive your physical health coverage through Apple Health coverage without a managed care plan, you will have the option to select a managed care plan for your behavioral health services.

A list of the available Behavioral Health Services Only plans can be found on the Apple Health managed care webpage.

How do I enroll in managed care?

If you are an American Indian or Alaska Native, or if you previously opted out of managed care you can opt in at any time. To enroll into managed care contact HCA at 1-800-562-3022.