There is some managed care in Alaska. It is more common in the lower 48. A managed care plan is linked to insurance. It may include Medicaid and Medicare. People enroll or subscribe to a managed care plan. Each plan has its own group of approved doctors and hospitals, called a “provider network.” Like other insurance, people often pay part of the cost out of their own pockets. This is called “co-pay.”
Often a person in a managed care plan is assigned to a primary care doctor called a “gatekeeper.” This doctor’s job is to see that the person receives routine medical care such as regular check-ups. This doctor is also the one who decides if the person needs to see a specialist trained in a certain condition.
There two major types of managed care plans. One type is a Health Maintenance Organization (HMO) and the other is a Preferred Provider Organization (PPO). An HMO requires a person to receive all care from providers inside the network. They won’t pay anything for services outside the network. A PPO gives people an option to use providers outside the network. PPOs are more common in Alaska. The co-pay might be higher outside the network.
Another type of managed care is called an Exclusive Provider Organization (EPO). An EPO is kind of a small PPO. It has a small number of providers in the network. These providers charge much less per patient because they each see a lot of patients.