LER425 Managed Care Benefit Plans

timer Asked: Feb 4th, 2019
account_balance_wallet $20

Question Description

Managed care benefit plans are increasing in popularity in recent years, and the most typical managed care plans are HMOs and PPOs.

  • Define each type of managed care plan.
  • Compare and contrast
    • how providers are paid by each plan.
    • flexibility of each plan in terms of choosing a health care provider in and out of network.
    • usage of gatekeepers.
  • If you had to choose one of these types of plans for your own benefits coverage, which would you choose and why?

Tutor Answer

School: University of Virginia



Managed Care Benefit Plans




Managed care benefit plans are personal insurances that are used to cover individuals for
medical purposes. In contemporary society, the cost of treatment has been a concern to many,
especially in the third world countries. As a result of this, hospitals, medical facilities, and other
health care providers usually sign contracts with these plans to cover the members at a reduced
cost. This paper, therefore, seeks to explore the meaning of the different Managed care benefit
plans, compare and contrast how payment is paid to providers by each plan, the flexibility of
each program, usage of gatekeepers and to evaluate and to give reasons for the best plan to
choose (Reference Cummings, 2016).
There are different types of Managed care plans. They include Health Maintenance
Organization (HMO), Preferred Provider Organization (PPO), Point of Service (POS), and
Exclusive Provider Organization (EPO). Health Maintenance Organization and Preferred
provider Organization are the major insurance covers. HMO is insurance that enables the
employers or companies to cover their employees for health care purposes at a much-reduced
cost through consultations with various doctors and hospitals. PPO is similar to HMO, but the
members have the freedom to choose the hospitals or doctors of their choice. This insurance
offer reduced costs to employees and members owed to their health insurance plan. POS is a type
of insurance that allows the individual members to choose the physician of their choice moving
on to the specialists. Last but not least, EPO is insurance that enables members to choose from
the health care providers within the n...

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awesome work thanks

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