Question

multiple select question
select all that apply
select all of the following that are true of hmos. (more than one answer may be correct)

they combine coverage of medical costs and delivery of healthcare for a prepaid premium.
patients are able to use any provider of their choice.
they use networks of physicians, hospitals, and other providers by negotiating contracts.
hmo stands for health maintenance operation.

Explanation:

Define Health Maintenance Organizations (HMOs)

Using the Managed Care Plans and Managed Care Organization knowledge points

• HMOs are a type of managed care plan.
• They combine the financing (coverage of medical costs) and delivery of healthcare services.
• Members pay a fixed, prepaid premium for comprehensive care.

Evaluate the first option

Using the Managed Care Plans knowledge point

• Statement: "They combine coverage of medical costs and delivery of healthcare for a prepaid premium."
• This is a core defining characteristic of HMOs.
• This statement is correct.

Evaluate the second option

Using the Managed Care Plans knowledge point

• Statement: "Patients are able to use any provider of their choice."
• HMOs restrict coverage to a specific network of contracted providers.
• Out-of-network care is generally not covered except in emergencies.
• This statement is incorrect.

Evaluate the third option

Using the Managed Care Plans and Managed Care Organization knowledge points

• Statement: "They use networks of physicians, hospitals, and other providers by negotiating contracts."
• HMOs build networks by contracting with providers at negotiated rates to control costs.
• This statement is correct.

Evaluate the fourth option

Using the Managed Care Plans knowledge point

• Statement: "HMO stands for health maintenance operation."
• HMO stands for Health Maintenance Organization, not operation.
• This statement is incorrect.

Answer:

• They combine coverage of medical costs and delivery of healthcare for a prepaid premium. (Correct answer)
• Patients are able to use any provider of their choice.
• They use networks of physicians, hospitals, and other providers by negotiating contracts. (Correct answer)
• HMO stands for health maintenance operation.