In managed care, what happens when an individual uses providers within the network?

When an individual uses providers within a managed care network, they typically benefit from lower costs or in some cases, no out-of-pocket expenses after meeting their deductible. Managed care plans are designed to encourage members to use a specified group of healthcare providers who have agreed to provide services at predetermined rates. This means that when members choose to stay within the network, they take advantage of reduced copayments, coinsurance, and overall lower premiums compared to using out-of-network providers.

The structure of managed care emphasizes preventive care and efficient cost management, making it financially advantageous for members to receive care from network providers. This is a core principle of managed care, promoting the use of in-network services to manage healthcare costs effectively and provide more affordable care options to members.