What is the goal of an HMO quizlet?

What is a HMO in simple terms?

HMO stands for health maintenance organization. HMOs have their own network of doctors, hospitals and other healthcare providers who have agreed to accept payment at a certain level for any services they provide. This allows the HMO to keep costs in check for its members.

What are the main characteristics of an HMO quizlet?

An HMO features managed care, prepaid services, co-pays, a gatekeeper primary care physician, a limited choice of providers, and a limited service area.

What are the typical features of a HMO plan?

HMOs typically offer lower costs, but you will have a more restrictive provider network, and you will have to coordinate your medical care through a primary care physician (PCP). Managed care plans try to reduce the cost of medical care while still maintaining quality care.

What is the main purpose of Health Maintenance Organization or managed care quizlet?

What is the goal of managed care? What does manage care tools and organizations do? merge clinical, financial, and administrative processes to manage access, cost, and quality of health care.

What is an HMO How does it differ from a PPO quizlet?

What is one difference between an HMO and a PPO? HMOs hire care providers, however, PPOs contract other independent providers thus allowing individuals to choose from a list of providers to see. One of the main provisions of the Affordable Care Act was the individual mandate.

What are 2 advantages of an HMO plan?

What are the three types of HMO models?

There are four types of HMOs: staff model, group model, network model, and independent practice association. HMOs offer excellent services but mostly for in-network options. HMOs are on par with deductibles and copayments compared to other types of insurance.

Which of the following is a characteristic of the staff model of an HMO?

A characteristic of a staff model health maintenance organization (HMO) is that it: employs salaried physicians. All of the following are types of health maintenance organizations (HMOs) EXCEPT the: preferred provider model.

What are the pros and cons of an HMO?

HMOs are usually more affordable than preferred provider organization (PPO) plans, but they offer patients less flexibility. HMO participants must choose a primary care provider (PCP) to coordinate their care. They must see only in-network providers; if not, they'll have to pay for those visits entirely out of pocket.

What does HMO stand for in Medicare?

Medicare Health Maintenance Organizations (HMOs) are private plans that the federal government pays to administer Medicare benefits.

What was the main purpose of the Health Maintenance Organization Act of 1973?

The Health Maintenance Organization (HMO) Act of 1973 provided for a Federal program to develop alternatives to the traditional forms of health care delivery and financing by assisting and encouraging the establishment and expansion of HMOs.

Which of the following best describes an HMO?

A health maintenance organization (HMO) is a network or organization that provides health insurance coverage for a monthly or annual fee. An HMO is made up of a group of medical insurance providers that limit coverage to medical care provided through doctors and other providers who are under contract with the HMO.

What is one major advantage of a health maintenance organization HMO )?

The main advantage of an HMO is the affordability. An HMO is especially affordable for people who only need basic medical care such as annual checkups and immunizations.

Which of the following best describes a health maintenance organization HMO quizlet?

Which of the following statements best describes a health maintenance organization (HMO)? Providers are employees of the organization.

What is a plan characteristic for patients with an HMO quizlet?

What is a plan characteristic for patients with an HMO? Restricted from seeing out-of-network prescribers.

What would be a characteristic of a prepaid HMO plan?

HMOs provide medical treatment on a prepaid basis, which means that HMO members pay a fixed monthly fee, regardless of how much medical care is needed in a given month. In return for this fee, most HMOs provide a wide variety of medical services, from office visits to hospitalization and surgery.

What type of managed care plan is more popular than an HMO?

Because of the network limitations, HMOs tend to be cheaper than the other popular type of managed care plans: PPOs. With a PPO, you can go to both in-network and out-of-network healthcare providers and hospitals and you don't need to have a primary care provider or referrals to see specialists.

Which is not an advantage of a HMO?

The Primary Disadvantage of an HMO Plan

You are limited to a smaller (typically local) network of providers – usually a particular hospital system. Additionally, visiting a specialist typically requires a referral from your primary care doctor.

What are the four main models of HMOs quizlet?

An HMO is distinguished from other types of plans by the following main characteristics: Staff, Group, Network, and IPA models.

What are the main characteristics of an HMO How do PPOs differ from HMOs?

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. Out-of-pocket medical costs can also run higher with a PPO plan.