What is a capitated plan?

A capitated plan is a type of health insurance coverage in California. It is a payment plan in which the insurance company pays a set amount of money, or a “capitation”, to a healthcare provider for each patient they serve. This payment is made regardless of the services the provider performs or the amount of care the patient receives, making it a fixed-cost system. The purpose of a capitated plan is to control healthcare costs. Instead of the insurer needing to pay for each service a patient receives, they pay a set amount and the provider is responsible for the cost of any treatments outside the scope of the capitation. In California, capitated plans are common in the Medi-Cal program. When providers accept capitation, they agree to provide all of the services that Medi-Cal members need for a set amount. This arrangement allows providers to know in advance how much compensation they will receive from the insurer. The advantage of a capitated plan for insurers is that it helps to control costs by limiting how much care a patient can receive. On the other hand, the downside is that providers may be inclined to provide less care than a patient needs in order to save money. Overall, capitated plans are a popular type of health insurance coverage in California. Providers receive a set amount of money for each patient they serve, and the insurer can limit healthcare costs by setting a fixed cost.

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What is a capitated plan?

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