Health Maintenance Organization (HMO) is best described as which?

Health Maintenance Organization (HMO) is best described as which?

• A. A fee-for-service model without a service area.
• B. A non-profit plan offering only hospital care.
• C. A managed care plan that bills on a capitation basis.
• D. A managed health care provider offering a comprehensive array of medical services on a prepaid basis within a service area.

Answer: (D)

An HMO is a managed care arrangement where care is delivered through a network of providers for a fixed, prepaid premium within a defined geographic area. Care is coordinated to emphasize prevention, and members receive a comprehensive range of medical services as long as they stay in-network within that service area. This prepaid, network-based, comprehensive approach within a geographic limit is what defines an HMO. Choices that describe fee-for-service without a service area, or that cover only hospital care, miss the prepaid and broad-scope, networked structure, and a description focusing only on capitation without the prepaid, network, and service-area aspects is incomplete.

An HMO is a managed care arrangement where care is delivered through a network of providers for a fixed, prepaid premium within a defined geographic area. Care is coordinated to emphasize prevention, and members receive a comprehensive range of medical services as long as they stay in-network within that service area. This prepaid, network-based, comprehensive approach within a geographic limit is what defines an HMO. Choices that describe fee-for-service without a service area, or that cover only hospital care, miss the prepaid and broad-scope, networked structure, and a description focusing only on capitation without the prepaid, network, and service-area aspects is incomplete.