Have You Considered a Managed Health Care Plan Lately?

Managed health care plans are a variation from traditional private medical insurance plans like indemnity health insurance. Managed care was first tried in the United States on a large scale about 20 years ago. The advantage to these plans is that they are structured to keep provider costs under control which results in more predictable and less out of pocket costs for plan members to receive medical services.

It helps to understand the basis for how doctors, hospitals and other medical service providers get paid in the United States in order to understand why and how managed care plans evolved and will continue to evolve. Medical care in the United States is a fee for service arrangement between patients and doctors. Doctors provide specific health services like yearly checkups or treatment for minor aches or ailments for routine care and oversee hospitalization and treatment for more serious illnesses or medical conditions. Patients pay fees to the doctor, hospital and other medical service providers for each of these services.

A traditional indemnity plan is based on reimbursing a portion of the fees, usually 80%, that a patient pays for medical services. Usually, a doctor or hospital will bill the indemnity insurance for their portion of the charges first and then bill the patient for the remaining amount to pay. For many people, indemnity insurance can leave them under insured, meaning these people have a hard time paying 20% of medical service charges in addition to having to meet a health insurance deductible at 100% of the charges before the insurance starts paying anything for services billed.

Managed care plans can be a better option for people that are under insured when using an indemnity plan. These plans work with medical service providers like doctors and hospitals to agree in advance the fees that will be paid for specific medical services. In turn, members that use these plans agree to give up flexibility of choice and choose a doctor or hospital from within the network of providers approved by the plan. Plan members might also pay a higher premium. In exchange for this, members usually only owe a fixed dollar amount copay for routine medical services with no or a lower health insurance deductible.

In summary, managed care plans can provide more predictable and lower out of pocket costs for those people that find themselves under insured with other types of private health insurance. What you give up in flexibility of choice in your doctor or hospital, you can gain with more financial piece of mind when planning how to pay for your health care expenses.