Which health plan is best for Medicaid?

When it comes to choosing the best health insurance to meet our unique needs, Americans have a lot to consider. This includes the approximately 74 million U.S. citizens (almost a quarter of the country’s population) who receive health coverage under Medicaid.

Before we explore the best options under Medicaid for your health needs, let’s take a quick moment to review exactly what Medicaid is.

What is Medicaid?

Medicaid is a health coverage program operated by federal and state governments to help with medical costs for some people who have limited income or those with certain disabilities. Each state operates its own Medicaid program, so each state has different eligibility criteria, rules and coverages.

Further, some states have chosen to use Managed Care Organizations (or MCOs) to help facilitate Medicaid or Medicaid Expansion programs. Each of these organizations has different features. Some states give Medicaid enrollees a choice to pick the best MCO for them, if they use more than one MCO for Medicaid coverages.

What is an MCO?

An MCO is a health plan that includes a network of doctors and hospitals with the goal of keeping people healthy through preventive care and education. This means, in some states, individuals who have Medicaid might get insurance cards, other documents and customer service from an insurance company, and not from the government of the state they live in.

So, which MCO is best for me?

The MCO you’ll select depends on which state you live in and the type of benefits that are important to you.

However, in general, people look for three main things when choosing a health plan:

  • The best benefits
  • The doctors they want to see
  • The medications they take

Let’s drill down a little into each one of these criteria.

The best benefits 

  • If you have a health condition, are pregnant or need certain care like hearing or vision benefits, it’s important to choose a Medicaid MCO plan that will work for you.
  • Most Medicaid plans have the same core benefits including primary care, hospital stays, emergency care, transportation to appointments and more.
  • However, extra benefits, like hearing and vision, or special programs to help you quit smoking, or receive rewards for taking care of your health, can vary between each MCO.
  • Take a moment to think about what kinds of coverage are most important to you. This will help you select the best plan to suit your needs.

The doctors you want to see

  • Different MCOs may have different provider networks (health care professionals who have partnered with health plans to contract for lower rates)
  • If keeping your current doctor is a high priority for you, make sure he or she is in the MCO’s provider network.
  • If you don’t have a regular doctor, this factor probably won’t weigh much on your decision.

The medications you take

  • Medications are included under the core benefits in Medicaid plans, but MCOs might use something called a formulary, too.
    • A formulary is simply a list of prescription drugs that the insurance covers.
    • Sometimes, you may also see it referred to as a preferred drug list.
    • If you take prescription medications, check if it is on the MCO’s Medicaid formulary.

What are my next steps?

Check with the Medicaid program of the state in which you reside for information about what MCOs are available. For a list of state contacts, visit https://www.medicaid.gov/about-us/contact-us/contact-state-page.html.

Sanford Health Plan is currently the MCO for the North Dakota Medicaid Expansion program. If you have questions about your ND Medicaid Expansion benefits, contact us at (855) 305-5060 or go to https://www.sanfordhealthplan.org/nd-medicaid-expansion.