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Created with Fabric.js 1.4.5 The amount you owe for health care services your health insurance plan covers before your plan begins to pay. California's Medi-caid health care program for child-ren and adults with limited income andresources. MANAGED CARE A broad term that describes the health insurance products available to most consumers in the health care marketplace today. There are 3 main types ofmanaged care plans: What is managed care? HMO Usually only pays for care within the network. You choose a primary care provider (PCP) who coor-dinates most of your care, including referrals. PPO (Health Maintenance Organizations) (Preferred Provider Organizations) Contracts with a network of "preferred" providers that you can choose from. You do not need to select a PCP and you do not need referrals to see other providers in the network. POS A combination of HMO and PPO. Each time you need health care, you can stay in the net-work or go outside the net-work without a referral from your PCP. (Point of Service) Why do we have managed care? To save us money by providing preventive health care services that will help us avoid serious, costly health problems in the long run. Also, managed care plans use "networks" to keep cost of services down. Commonly Used Terms NETWORK A group of contracteddoctors, hospitals, clinics, pharmacies, labs, etc. that are avail-able in your managed care plan to keep cost of services low.Going outside thenetwork results inout-of-pocket costs. DEDUCTIBLE PREMIUM COPAY MEDICARE The amount that must be paid for your health insurance or plan. A federal health insurance program for people who are age 65 or older and certain younger peo-ple with disabilities. A fixed amount you pay for a covered health care service, usually when you receive the service. MEDI-CAL MEDI-CAL FORMULARY A list of prescription drugs covered by a prescription drug plan. created by Annie Ng
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