What is the difference between health plan and IPA?


Editorial team Published on

An Independent Physician Association (IPA) is a network of private, independent doctors who team up to negotiate contracts with insurance companies, while a health plan is the insurance company or organization that pays for your medical care.

Key Differences

  • Role: A health plan provides your coverage and pays medical bills. An IPA is an organization of local doctors who contract with that health plan as a group.
  • Ownership: A health plan is run by an insurance company. An IPA is run by the independent doctors themselves.
  • Your Care: Your health plan dictates your overall benefits. Your IPA provides your actual care network (like your primary doctor and local specialists).

How They Work Together

When you enroll in an HMO or managed care Health Insurance Plans, the health plan often asks you to pick a medical group or IPA.

  1. You buy a policy from a health plan (such as L.A. Care, Anthem, or Blue Shield).
  2. You select a primary care doctor who belongs to a specific IPA (such as Allied Physicians IPA or Hill Physicians).
  3. The health plan pays the IPA, and the IPA manages the network of doctors, referrals, and local medical services for you.