risk HMO

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 ?
5 percent of HMO Medicare beneficiaries who could not be matched to a specific Medicare risk HMO were dropped (Gabel 1997).
PacifiCare initially provided full risk HMO coverage to approximately 48,000 UFCW members.
One-quarter of those people--or 17 percent of all enrollees--were enrolled in a risk HMO during the year, and the other three-quarters remained in the Medicare FFS Program.
Studies have shown that a high Medicare capitation rate is an important predictor of capitated risk HMO enrollment in Medicare (Adamache & Rossiter 1985; Porell & Wallack 1990).
Approximately 5 percent of individuals in the 1993 sample were enrolled in a Medicare risk HMO for the entire year, while 95 percent were in FFS settings for the entire year (Table 4).
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.
Less than 10 percent of the disabled are in a Medicare risk HMO and only 5 percent have a medigap plan.
In 1997 alone, Medicare risk HMO enrollment has growth by approximately 100,000 per month.
PacifiCare's Secure Horizons currently has 965,000 Medicare risk HMO members enrolled in nine states.
Between December 1994 and December 1998, Medicare risk HMO enrollment nearly tripled, rising to 6.
Our study of pre-enrollment expenditures indicates that higher 1993 reimbursements were associated with a lower probability of Medicare risk HMO enrollment in 1994.