Healthcare Programs - Types of Managed Care Plans

HEALTHCARE PROGRAMS - TYPES OF MANAGED CARE PLANS

Types of Managed Care Plans

Managed care plans typically cover a wide range of health services such as preventive care and immunizations for adults and children, general checkups, diagnosis and treatment of illness (including tests, doctors’ visits, prescription medications, and hospital care), and complete prenatal and newborn care. Most managed care plans offer some services for the diagnosis and treatment of mental health conditions and substance abuse problems. Managed care plans have agreements with doctors, hospitals, and health care providers to give a range of services to plan members at reduced cost. In general, there is less paperwork and lower out-of-pocket costs for a managed care type plan. In some managed care arrangements, members must seek care from within the health plan’s network of providers. In other arrangements, members can obtain services from any provider, but the health plan will pay more of the bill if the patient obtains care from a network provider. Two primary components of a managed care plan are systems that oversee the amount and type of health care services being used and provider reimbursement methods that discourage unnecessary care. Managed care organizations often require members to get approval before obtaining certain services. Some managed care organizations also give providers financial incentives to eliminate unnecessary care. There is a monthly premium to be paid. There will is also an annual deductible and a copayment each time the doctor is accessed, emergency room visit, or get a prescription filled. The amount of deductable and copayments may depend on how much the premium is. In general, a plan that requires use of a network provider, has a high deductable, and high copayments will have lower premiums. A plan that allows use of any provider has a lower deductible, and lower copayments will have higher premiums. Most managed care plans have a...