Managed care is a system for providing health care benefits through health plans. People enrolled in a health plan must get their medical care through the health plan. The health plan may require you to:
Choose a primary care clinic, which will coordinate all your care
Get a referral from your primary care clinic before you see a specialist
People age 65 and older must enroll in a health plan. You will get information in the mail to help you choose a Minnesota SeniorCare Plus (MSC+) health plan. If you have Medicare and want to get all of your Medicare and Medical Assistance services through one health plan, you can choose to enroll in a Minnesota Senior Health Options (MSHO) health plan.
Some counties have more than one health plan for you to choose from. Each plan has different doctors and dentists who you may see. You should get booklets in the mail listing the primary care clinics belonging to each plan. You may want to choose a plan that your current doctor or dentist participates in. If you do not have a doctor, you may want to choose a plan with doctors close to your home or workplace.
The program you are approved for determines the benefits you get. The health plan does not determine your benefits. The health plans have different rules about how you receive your benefits.
If there is more than one health plan available in your county, you may be able to change health plans. You may change health plans with the following limits:
Once during the first year you are enrolled in a health plan.
Once each year during the annual health-plan-selection period (formerly called open enrollment ). Annual health-plan-selection notices are mailed in the fall. If you change health plans during this period, the change will take effect Jan. 1 of the following year. For more information, see our annual health-plan-selection web pages.
Each health plan has a list of medications they cover (called a formulary). If your doctor thinks that a medication not on the list is the best medication for you, ask your doctor to submit a request for authorization to the health plan. The health plan may approve the medication even if it is not on their formulary.
The health plan must send you a notice if it denies, ends or reduces services you or your doctors have requested. The notice will tell you why the plan decided to deny, end or reduce your services. If you disagree with the health plan, you may file an appeal or ask for a state fair hearing.