Managed Care Explained

What is Medicaid managed care? We will tell you everything you need to know during this guide.

Managed care is a healthcare delivery system used to manage quality, utilization and cost. Managed care refers to a group of activities that helps lower the cost of offering for-profit healthcare services and health insurance while boosting the quality of healthcare services. IEHP is a managed health care plan that organizes care for their member. IEHP works with doctors, hospitals and other health care providers to give improved health care coordination and quality of care to the members they serve.

Medicaid managed care helps to provide Medicaid health benefits and other services through managed care organizations, also known as MCOs and state Medicaid agencies. Managed care organizations accept a specific payment per member per month for their services.

The main goals of Medicaid-managed care are to improve healthcare outcomes, healthcare quality and health plan performance.

Managed-care plans tend to ask for less paperwork and offer a lower premium payment. The choice of treatment, drugs and doctors are limited. Healthcare providers, hospitals and doctors make plans with managed care plans to serve members at a lower rate.

When you have a managed care plan, you are need to choose a primary care doctor or PCP, who is part of the network, the doctor you choose will take care of all your medical needs, including annual exams, preventive care and treatment for common illnesses. Your PCP will decide whether you need to be referred to a specialist like an oncologist. With a managed care plan, you cannot get coverage for specialist services without getting referred by your PCP.

The cost for a managed care plan is typically less than a fee-for-service plan. You will typically pay a copayment every time you visit your doctor, as long as they are part of the plan network. This cost will depend on the type of managed health plan you choose.

MCO Medicaid can offer members the chance to select a health plan under Medicaid. Here is what you should look for in a Medicaid health plan:

• Excellent plan coverage. When you are looking for a Medicaid health plan, you should look for something that covers everything you could possibly need, including hospital stays, pregnancy and newborn care, hospice and palliative care, emergency services, outpatient or ambulatory services, transgender services, mental health services, rehabilitative services, prescription drugs, lab services, preventative and wellness services, sensitive services, chronic illness management, substance use treatment services, dental services, vision services, pediatric services, telehealth services, non-medical transportation or NMT, non-emergency medical transportation or NEMT and long-term services and supports or LTSS.
• Low premiums. Look for a Medicaid health plan that offers low to no premium payments. Some Medicaid plans offer a $0 monthly premium.
• Accessibility. You should also look for a Medicaid health plan accessible to you and others who need it, including children, adults, seniors and those with disabilities who live in your area.

With IEHP, you also get access to:

• A network of more than 8,000 doctors,
• Specialists and other health care providers
• Care coordination
• 24-Hour Nurse Advice Line
• Vision services
• Urgent Care centers
• Healthy lifestyle classes and programs
• And so much more!

If you need healthcare coverage or have questions about what IEHP offers, call 1-866-294-IEHP (4347), 8 a.m.-5 p.m. Monday-Friday. TTY users should call 1-800-720-IEHP (4347). You’ll speak to one of our friendly bilingual Enrollment Advisors.