What is a capitated plan?

A capitated plan is a type of health insurance plan used in Washington State. It is a system that pays providers a set fee per patient, no matter how many services the patient actually receives. For example, a provider might receive a flat fee for treating a patient for a year, regardless of how many times the patient visits the provider during that year. In this way, providers are given an incentive to provide quality care at an efficient rate, since they will make more money if they can keep care costs lower. This also serves to reduce overall healthcare costs, since providers will have a financial incentive to keep expenses down. In Washington State, all insurers must offer a capitated plan option, and some insurers may only offer them. Capitated plans are usually preferred by those who prefer cost certainty and those who need a high level of continuity of care. While capitated plans are popular in Washington State, they can come with drawbacks. For example, patients may not be able to choose their own provider and may have limited access to certain treatments or medications. As well, providers may perform unnecessary services to increase their fees, leading to higher costs for patients and insurers.

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What is a capitated plan?

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