Which term refers to an insurance model that administers basic and supplemental health services to enrollees who pay a fixed fee?

Which term refers to an insurance model that administers basic and supplemental health services to enrollees who pay a fixed fee?

• A. Medicare Advantage Plans
• B. Bundled Payments
• C. HMOs
• D. FPL

Answer: (C)

Health Maintenance Organizations deliver care through a prepaid, fixed-fee arrangement for a defined network of providers. Enrollees pay a set premium (often with copays) and receive both basic and, in some plans, additional covered services within that network. Care is coordinated by a primary care physician who acts as a gatekeeper, and services outside the network are typically not covered except in emergencies. This prepaid, network-based structure is what distinguishes HMOs from other models such as bundled payments, poverty-level measures, or other private-plan arrangements.

Health Maintenance Organizations deliver care through a prepaid, fixed-fee arrangement for a defined network of providers. Enrollees pay a set premium (often with copays) and receive both basic and, in some plans, additional covered services within that network. Care is coordinated by a primary care physician who acts as a gatekeeper, and services outside the network are typically not covered except in emergencies. This prepaid, network-based structure is what distinguishes HMOs from other models such as bundled payments, poverty-level measures, or other private-plan arrangements.