How Do I Get Enough Managed Care Coverage?

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  • Written By: Malcolm Tatum
  • Edited By: Bronwyn Harris
  • Last Modified Date: 05 October 2018
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Making sure that there is enough managed care coverage is very important to any household. Whether that care is provided in the form of some type of group insurance coverage or a personal care health plan, attention must be given to the scope of coverage provided in the terms and conditions. Plan subscribers should also have a solid understanding of any limitations on pre-existing health issues, and even what the terms of the plan call for in the way of co-pays or deductibles that must be met before the plan begins to pay anything.

One of the first steps in evaluating the scope of managed care coverage is to know exactly what the provisions of the plan do and do not cover. Here, the goal is to identify the benefits associated with typical and usual healthcare needs, such as providing assistance with the cost of routine doctor visits and physical examinations. The amount of support provided with covering the cost of prescription medication, including how name brand medication is covered when generic versions are available, should be taken into account. From there, care should be taken to determine what benefits apply to physician ordered tests, surgical procedures on both an outpatient basis and those performed in a hospital or similar facility, and even other types of medical care such as psychiatric services.


Along with understanding what the current managed care coverage does include, it is also important to identify what type of medical services are not provided for in the terms and conditions. Depending on the state of your health and any conditions that are not present, there may be a need to secure some sort of secondary insurance plan that does include coverage of those particular issues. While more expensive in terms of having another premium to pay, creating a health strategy that includes both a primary and a secondary health insurance plan is a good idea. This is especially true if the long-term care provisions in the primary policy are not particularly comprehensive.

Cost is also a factor when evaluating the amount of managed care coverage available. You want to understand clearly what type of deductibles and co-pays are included in the plan, ranging from a co-pay for medication and doctor visits all the way through to deductibles for surgery or major medical events. Keep in mind that the purpose is to determine how well the managed care coverage fits your needs. This means a plan that is sufficient for one person may be completely inadequate for another who has a different set of circumstances to consider.



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