Assume you are a Maryland resident and Medicaid recipient looking to enroll in a managed care plan, review the Maryland Managed Care Website at: Benefits Offered or Covered Services You want a plan that offers a comprehensive benefits package including preventive care as well as treatment programs for chronic disease management. Also, you may need emergency care and/or care away from home. Cost vs. Benefits Managed care plans vary widely in the cost of services offered. It may be tempting to base your selection primarily on the periodic, out-of-pocket costs to you. You can’t be sure that the least expensive plan will give you all the medical services you need. Services of the Primary Care Physician Choosing your primary care physician (PCP) may be the most important decision you make when enrolling in a managed care plan. The following questions are important when choosing your plan: Please use the answers to each question to provide a critical analysis of the program. DO NOT SIMPLY ANSWER THE QUESTIONS.Prescription Drug Benefits When evaluating a health plan it is very important to know what kind of prescription drug benefits the plan offers. Depending upon the plan, there are several systems that have been implemented in efforts to control costs. Some plans offer a “generic only” plan. Use the following questions to guide your analysis in an academic response. DO NOT SIMPLY ANSWER THE QUESTIONS. Provider Network and Geographic Service Area Be sure you inquire from the Provider Membership Directory which providers are included in the network and where they are located in your community. These are just a few questions you may ask when deciding whether the HealthChoice Provider Network is suitable to you. Commitment to Quality of Care and Service It is worthwhile to find out if the plan has been accredited by the National Committee for Quality Assurance (NCQA). NCQA is the most common accrediting body for network plans. Customer Satisfaction There are various objective forms of measurement used to determine “quality services” given by managed care plans such as accreditation, HMO report cards and/or publications produced by the industry. You would be wise to look at any that measure customer satisfaction.The National Committee for Quality Assurance (NCQA) mission is to provide information that enables purchasers and consumers of managed health care to compare plans based on quality. Their web site may be reached at Limitations, Maximums, or Exclusions Lifetime Cap refers to the maximum dollar amount of benefits available to a consumer in a managed care plan during his or her lifetime. This amount becomes important when confronted with a life-threatening disease or accident that requires prolonged care involving expensive therapeutic intervention and support.
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