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 ?
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.
In total, FHS health plans will not renew Medicare risk HMO contracts in 32 counties effective Jan.
Between December 1994 and December 1998, Medicare risk HMO enrollment nearly tripled, rising to 6.
However, effective January 1, 1999, the company will no longer participate in the following areas where it currently offers Medicare Risk HMO plans: the states of Delaware, Maryland, Massachusetts, New Hampshire, Rhode Island and Virginia; the District of Columbia; Windham and Tolland counties in Connecticut; Polk County in Florida; and Marin and Sonoma counties in California.
Supplementary Insurance Total Primary Secondary Number in Thousands Total 23,929 22,671 1,257 Medicare Risk HMO 2,404 2,384 20 Medicaid 4,039 3,949 90 Employer-Sponsored(1) 10,452 10,162 290 Individually Purchased 3,818 3,075 743 All Other(2) 787 774 14 Switched Coverage During Year 2,428 2,328 101
To our knowledge, this is the first Georgia HMO which has entered into a Medicare-risk agreement with the Health Care Financing Administration and currently covers approximately 5,000 lives under its Medicare risk HMO.
Both PacifiCare of Washington and Secure Horizons, the company's Medicare Risk HMO, grew rapidly under her leadership, with a combined membership of nearly 140,000 commercial and Medicare members.

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