A form of health insurance that provides incentive for the insured to use specific providers or a list of providers.
In most managed care plans, you can only go to doctors, specialists, or hospitals on the plan?s list except in an emergency. Plans must cover all Medicare Part A and Part B health care. Some managed care plans cover extra benefits, like extra days in the hospital. In most cases, a type of Medicare Advantage Plan that is available in some areas of the country. Your costs may be lower than in the Original Medicare Plan.
A health benefit plan that creates a financial incentive to use providers that are in the health plan’s network. Some managed care plans limit coverage to care obtained from network providers. Others pay more if the member obtains care from within the network, but will pay something for covered services obtained from non- network providers. Two of the primary components of a managed care system are systems that oversee the amount and type of health care services being used (" utilization review") and provider reimbursement methods that discourage unnecessary care.
a health insurance company that provides coverage in a managed or coordinated way
Any health plan that requires or creates incentives for an enrollee to use providers that are owned, managed, or under contract with the insurer offering the health benefit plan.
Dental insurance plans that control dental benefit expenditures by reducing reimbursement levels, limiting access to care, transferring risk to the dental providers, and restricting the level, type and frequency of care.
A type of health care plan that utilizes the principles of managed care; examples include health maintenance organizations and preferred provider organizations.
A health plan that uses managed care arrangements and has a defined system of selected providers that contract with the plan. Enrollees have a financial incentive to use participating providers that agree to provide a broad range of services to them. Providers may be paid on a pre-negotiated basis. (See also HMO, Point Of Service Plan (POS), and Preferred Provider Organization.) Out-Of-Pocket Maximum The highest amount of money you will pay in a year for deductibles and coinsurance plus regular premiums.
A health plan (like an HMO) run by a private company or entity that receives a set amount of money from the government to provide Medicare-covered benefits.
A term that typically refers to an HMO, POS, PPO or Exclusive Provider Organization (EPO), but technically means any health plan with specific requirements, like pre-authorization or second opinions, that enables your primary care physician or generalist to coordinate or manage all aspects
A term that typically refers to an HMO, Point of Service, EPO, or PPO, but technically means any health plan with specific requirements, like pre-authorization or second opinions which enable your primary care physician to coordinate or manage all aspects of your medical care.
A term that typically refers to an HMO, Point of Service, EPO, or PPO; any health plan with specific requirements, such as pre-authorization or second opinions, which enable the primary care physician to coordinate or manage all aspects of the patient's medical care.
Health care plan based on practice guidelines or protocols that health care providers must follow. The goals of a managed care plan are to lower health care costs, provide as comprehensive coverage as possible, and improve the methods used to select health care providers.
