“Managed care” is a term you may have heard before, but perhaps weren’t sure what it meant. It’s pretty simple really. If you have managed care, you belong to a health insurance plan that contracts with healthcare providers and medical facilities to provide care at a reduced cost. Its main purpose is to better serve plan members by focusing on prevention and care management, which helps produce better patient outcomes and healthier lives. Managed care also helps control costs so you can save money.
There are other financial incentives for members of managed care plans, including tiered copays for prescription drugs. For example, when you choose generic drugs you’ll pay less than if you opt for brand-name drugs.
Three different kinds of managed care plans are available.
Most likely, you’ve come across this terminology: HMO (Health Maintenance Organization), PPO (Preferred Provider Organization) and POS (Point of Service).
- HMO: lower monthly premiums, comprehensive benefits
With an HMO plan, a primary care physician (PCP) typically must be selected. The PCP is responsible for coordinating all the members’ healthcare — a referral is often required before seeing a specialist or another physician. HMOs also have provider networks, and require healthcare services within their network.
- PPO: offers provider flexibility, higher monthly premiums
Like an HMO, PPO plans also have a network. The big difference is that members can go out of network for their healthcare — often without a referral — but they will pay more. Most of the time, monthly premiums are higher than an HMO.
- POS: benefit levels vary for in-network vs. out-of-network
POS plans are much like HMOs in that members must select a primary care physician. They’re also similar to PPOs — members can seek healthcare outside the network but they will pay more. Monthly premiums are also typically higher than an HMO.
Medicare Advantage (Part C) is personal insurance from private companies that’s approved by Medicare. Plan types that are available run the gamut — from HMO to PPO to POS — and include coverage for preventive healthcare, routine and major care, prescription drug coverage, even emergency coverage when traveling outside Nevada. You can also get additional plan benefits beyond Original Medicare, such as dental and vision care, wellness programs and transportation.
How does Intermountain Healthcare, support managed care?
Intermountain Healthcare has a network of nearly 300 primary care providers and more than 1,500 specialists. With medical clinics and specialty care affiliates throughout Southern Nevada, we provide patient-centered, comprehensive primary care, specialty care and urgent care services. In addition, for patients age 65+ and enrolled in certain Medicare Advantage plans, our myGeneration Senior Clinics offer senior-focused healthcare at nearly 30 convenient locations.
See how myGeneration Senior Clinics and managed care help make for a healthier you. Call us at 702-852-9000.