TeachMeFinance.com - explain Risk-Based Health Maintenance Organization-Competitive Medical Plan
Risk-Based Health Maintenance Organization-Competitive Medical Plan The term 'Risk-Based Health Maintenance Organization-Competitive Medical Plan ' as it applies to the area of Medicare in the United States can be defined as ' A type of managed care organization. After any applicable deductible or co-payment, all of an enrollee/member's medical care costs are paid for in return for a monthly premium. However, due to the 'lock-in' provision, all of the enrollee/member's services (except for out-of-area emergency services) must be arranged for by the risk-HMO. Should the Medicare enrollee/member choose to obtain service not arranged for by the plan, he/she will be liable for the costs. Neither the HMO nor the Medicare program will pay for services from providers that are not part of the HMO's health care system/network'.
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