Question

multiple select question

select all that apply

which of the following are true of managed care insurance plans?

premiums and deductibles are typically higher than those of traditional indemnity insurance.
choice of and access to providers are restricted.
mcos establish links between provider, patient, and payer.
premiums and deductibles are lower than those of traditional indemnity insurance.
the mco has no control over what services the providers perform.
patients have unlimited access and choice of providers.

Explanation:

Analyze managed care cost structures

Using the Managed Care Plans and Indemnity Plans knowledge points, we compare financial structures. Traditional indemnity plans offer maximum freedom but have higher premiums and out-of-pocket costs. Managed care plans restrict networks to lower overall costs, meaning their premiums and deductibles are typically lower than traditional indemnity insurance. Thus, the first option is false, and the fourth option is true.

Evaluate provider choice and access

Using the Managed Care Plans knowledge point, we analyze patient access. Managed care plans restrict patients to a specific network of approved healthcare providers. Choosing an out-of-network provider results in higher out-of-pocket costs or no coverage. Therefore, choice of and access to providers are restricted, making the second option true and the sixth option false.

Examine organizational relationships

Using the Managed Care Organization knowledge point, we look at how these entities function. Managed Care Organizations (MCOs) actively establish contracts and operational links between providers, patients, and payers to manage cost, quality, and administration. Thus, the third option is true.

Assess provider service control

Using the Managed Care Organization knowledge point, we evaluate clinical oversight. MCOs utilize utilization reviews, pre-authorization requirements, and clinical guidelines to control and monitor the services providers perform. Therefore, the statement that the MCO has no control is false.

Answer:

• Premiums and deductibles are typically higher than those of traditional indemnity insurance.
• Choice of and access to providers are restricted. (Correct answer)
• MCOs establish links between provider, patient, and payer. (Correct answer)

<mcq-correct>Premiums and deductibles are lower than those of traditional indemnity insurance.</mcq-option>

• The MCO has no control over what services the providers perform.
• Patients have unlimited access and choice of providers.