risk HMO

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risk HMO

A health plan in the US which assumes insurance risk and receives a capitated payment for each enrollee, amounting to 95% of the average local payment for traditional Medicare.

Pros
Risk HMOs save money for Medicare, provide expanded benefits, guarantee enrollment, and allow easy disenrollment.
 
Cons
Chronically ill patients may be at a disadvantage; aggressive marketing and inadequate appeals process may harm the unwary consumer.
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References in periodicals archive ?
This system includes multiple product lines such as commercial HMO, Medicare risk HMO, Point-of-Service and PPO plans.
released today the results of its survey of 2,673 Medicare risk HMO members in the Southern California area.
If Medicare Risk HMO membership grew to 40 percent, Medicare would save about $38 billion in 1995 dollars.
As a Medicare Risk HMO, the federal government pays Senior Plan a monthly fee for each Medicare beneficiary enrolled in the program.
5 percent of HMO Medicare beneficiaries who could not be matched to a specific Medicare risk HMO were dropped (Gabel 1997).
In 1997 alone, Medicare risk HMO enrollment has growth by approximately 100,000 per month.
com Medicare Risk HMO Member Survey included more than fifteen thousand members of Medicare HMOs across the country and was conducted as a cooperative venture of more than 40 mid- and large-sized employers and Caredata.
By 1999 there were over 6 million Medicare risk HMO members--a nearly 500-percent increase from 1991--comprising 17 percent of the Medicare population.
BCC will continue its Medicare risk HMO and Medicare supplement offerings and this action will not affect those products in any way.
Less than 10 percent of the disabled are in a Medicare risk HMO and only 5 percent have a medigap plan.
PacifiCare's Secure Horizons currently has 965,000 Medicare risk HMO members enrolled in nine states.
In total, FHS health plans will not renew Medicare risk HMO contracts in 32 counties effective Jan.

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