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.
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.
Between December 1994 and December 1998, Medicare risk HMO enrollment nearly tripled, rising to 6.
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

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