Georgia Navigator Practice Exam

What is typically a characteristic of managed care plans?

1. High premiums with no cost-sharing

2. Limited choice of healthcare providers and services

3. Comprehensive coverage without exclusions

4. Any provider can be seen without prior approval

The correct answer is: Limited choice of healthcare providers and services

Managed care plans are designed to control healthcare costs while providing coordinated services to members. A defining characteristic of these plans is the limited choice of healthcare providers and services. This restriction arises from the plan's network system, where members typically must seek care from a list of approved providers. The chosen providers usually have arrangements with the managed care organization to deliver services at negotiated rates, which helps keep overall costs down for both the providers and the patients. This limited choice is their way of managing care effectively, ensuring that patients receive necessary services while keeping expenses predictable. If a member chooses to see a provider outside of this network, they often face higher costs or may not have coverage at all. Unlike traditional insurance plans that might cover a broader range of providers without such limitations, managed care plans necessitate adherence to a network to benefit from lower out-of-pocket expenses.