What is a primary difference between an HMO and a traditional insurance company quizlet?
Asked by: Mr. Dallas Bergstrom | Last update: January 3, 2026Score: 4.2/5 (34 votes)
What is a primary difference between an HMO and a traditional insurance company?
An HMO provides comprehensive health-care services to the insured for a fixed periodic payment. There may also be a nominal fee paid for each visit to a health-care provider. Unlike traditional insurance, HMOs actually provide the health care rather than just making payments to health-care providers.
What is the primary difference between an HMO and a PPO quizlet?
An HMO locks patients into receiving services from providers with whom it has contacts, whereas a PPO allows patients to choose among providers in return for higher deductibles and copayments.
Which is a primary difference between individual and group health insurance quizlet?
individual insurance is when a person purchases a policy and agrees to pay the entire premium for health coverage. Group insurance is generally purchased through an employer. The premium is split between the employer and the person being insured.
What is a primary difference between a health maintenance organization (HMO) and a preferred provider organization (PPO)?
HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral.
PPO vs HMO: What's the Difference?
What are 3 major differences between HMO and PPO insurance?
Choosing between an HMO or a PPO health plan doesn't have to be complicated. The main differences between the two are the size of the healthcare provider network, the flexibility of coverage or payment assistance for doctors in network vs out of network, and the monthly payment.
How does a Health Maintenance Organization differ from a traditional insurer HMO?
HMOs have lower monthly premiums and lower out-of-pocket costs. For example, there are no deductibles in CalPERS HMO plans. And you won't need to file claim forms when receiving care in the HMO network. Unless it's an emergency, however, HMO plans require you stay within their network for care.
What is the difference between primary insurance and insurance company?
The insurance that pays first (primary payer) pays up to the limits of its coverage. The insurance that pays second (secondary payer) only pays if there are costs the primary insurance didn't cover. Tell your doctor and other health care providers if you have coverage in addition to Medicare.
Which is the primary difference between group insurance and individual insurance?
Group insurance is a health insurance plan that you provide to your employees and their dependents. Individual health insurance is obtained by an employee or provided by their family member and is not obtained through your business.
What are the two major differences between managed care and indemnity insurance?
The major difference between indemnity (non- network based coverage) and managed care plans (network-based coverage) concerns choice of doctors, hospitals, and other providers; out-of-pocket costs for covered services; and how bills are paid.
Why would a person choose a PPO over an HMO?
PPO plans provide more flexibility when picking a doctor or hospital. They also feature a network of providers, but there are fewer restrictions on seeing non-network providers. In addition, your PPO insurance will pay if you see a non-network provider, although it may be at a lower rate.
What is the function of the primary care provider in a managed care plan?
Under managed care, a primary care provider (PCP) wields considerable power. He or she is the gatekeeper who holds the keys to the specialized medical care you may need. Above this doctor, though, is the managed care plan itself -- the PCP's gatekeeper.
What is the difference between an HSA and an HMO according to the information in this chapter?
An HSA is a kind of savings account for people enrolled in a high-deductible healthcare plan and is used to pay for medical costs. An HMO is a low-cost health insurance plan that gives you access to a specific network of healthcare professionals.
What is the difference between managed care and traditional health insurance?
Under most managed care plans, medical services such as well-baby care, immunizations, mammography, other cancer screenings, and physicals are routinely covered. These preventive healthcare services are typically not covered by traditional insurance plans. Managed care is proactive – instead of reactive – healthcare.
What is one way in which HMOs are different from traditional health insurance policies?
Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.
What is the purpose of the HMO?
What Is the Purpose of a Health Maintenance Organization? The purpose of a Health Maintenance Organization is to provide integrated and preventative care while keeping costs low. HMOs rely on in-network physicians to refer their patients to the right specialists and receive the well-rounded care they need.
Which is the largest health care program in the United States?
Medicare is the single largest payer for health care services in the United States.
What are the primary categories of insurance?
- Life Insurance.
- Health Insurance.
- Fire Insurance.
- Marine Insurance.
- Vehicle Insurance.
What is the nickname for the Affordable Care Act?
The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act (PPACA) and informally as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010.
What is the difference between a health plan and an insurance company?
At a fundamental level, a health plan refers to the strategic approach taken to ensure the health needs of an individual or group, while health insurance is a financial tool that covers or subsidizes the cost of medical care.
What is the primary health insurance plan?
A Primary Plan is a Group Health Benefit Plan, an individual health benefit plan, or a governmental health plan designed to be the first payer of claims (such as Medicare) for an Insured Person prior to the responsibility of this Plan.
What is the difference between an insurance provider and an insurance company?
The entity that provides the policy is an insurance company which is also as a payer. A provider is an individual, group, agency, hospital, or anyone else that agrees to provide services under their agreement with the payer.
What is the difference between HMO and traditional insurance?
The key difference between an HMO and an insurer is that HMOs provide the promised coverage to the member (either directly or indirectly) while traditional insurance simply pays for care that the policyholder has obtained, after the care was rendered.
What is one of the biggest differences between HMO and PPO?
Choosing between an HMO and a PPO plan comes down to how you see your doctor. An HMO plan will provide more of a partnership with your doctor, and a PPO plan will allow you to access any doctor or hospital.
What is the primary difference between a health maintenance organization HMO and an exclusive provider organization EPO )?
EPO: A larger network makes life easier
Like HMOs, EPOs cover only in-network care. But the networks are generally larger. They may or may not require referrals from a primary care physician. Premiums are higher than HMOs, but lower than PPOs.