Managed Care Plans

Every patient and health insurance company is faced with a difficult realty: the ever-increasing costs of health care. While there is still no solid consensus on the cause of more expensive healthcare or how to fix it, insurance companies have taken steps to dial back costs by offering managed health care plans. These common health plans include health maintenance organizations (HMO), preferred provider organizations (PPO), and point-of-service (POS) plans. Such plans link their patients into a healthcare provider network.

The way these plans work starts with insurance companies constructing a system of doctors, medical specialists, clinics, hospitals and pharmacies. Health coverage providers negotiate with each partner in the network to get discounts on medical care services, reducing costs to health insurance companies and lowering how much patients pay out-of-pocket. This setup is mutually beneficial for the doctors and care providers in the network, because they tend to see more patients and generate more business.

Saving money always comes with its own costs. Managed care health coverage plans tend to restrict flexibility in patient choice of doctors, specialists, hospitals and pharmacists. Additionally, managed care policyholders have to be careful about which medical care providers they choose to see, because going outside of the network means a lot more out-of-pocket health expenses.

Understanding Your Provider’s Network

If you are going to purchase an affordable managed health coverage plan, your best shot at saving the most money is by understanding how your network actually works. Firstly, there are two different kinds of medical care providers from the perspective of a health insurance company offering managed care plans: in-network, those which are plan members and will be better-covered; and out-of-network, those which are non-members and are covered scarcely if at all. Certain plans, such as those offered by HMOs, won’t provide any coverage for care purchased outside of the network, so it’s usually much more cost-effective to shop from the member providers on your plan.

Finding out exactly who is and is not on your plan is actually fairly easy. Whenever you enroll in a managed care plan, health insurance companies will provide you with a list of approved care providers and may even have an internet search tool for nearby, in-network providers.

When discussing managed health care plans, the question that always tends to come up is whether a patient may keep a doctor they like if they buy a managed care policy. One way to resolve this is to go with a more flexible plan, like a PPO, which will cover some of the costs of a doctor you choose out-of-network. For more expensive care, such as from a specialist or hospital, you can always go back to the network.

Affordable Health Insurance

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