Definitions for "Managed care plan"
Keywords:  epo, hmo, ppo, incentive, enrollee
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.