Georgia Navigator Practice Exam

Which of the following describes managed care plans?

1. They operate without any contracts with providers

2. They provide unlimited access to all healthcare services

3. They contract with providers to offer services at lower costs

4. They do not require referrals to specialists

The correct answer is: They contract with providers to offer services at lower costs

Managed care plans are characterized by their contractual agreements with healthcare providers to deliver services at lower costs. This arrangement allows managed care organizations to negotiate rates and ensure quality care while controlling expenses for both the plan and its members. By entering into these contracts, managed care plans can streamline access to a network of providers and facilitate coordinated care, which is a fundamental goal of this healthcare model. This differs significantly from the other options. For example, operating without contracts with providers would undermine the cost savings and coordinated care that managed care plans aim to achieve. Unlimited access to all healthcare services is generally not a feature of managed care plans, as they typically have limitations and guidelines for care to maintain cost efficiency. Additionally, the requirement for referrals to specialists is a common practice in many managed care plans, particularly those structured as Health Maintenance Organizations (HMOs), to ensure appropriate care and manage healthcare costs.