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Medicare's point-of-service
1Birch and Davis Health Management Corporation, Silver Spring, Maryland, USA.
Nursing Management
|October 1, 1996
Summary
New Health Care Financing Administration (HCFA) guidelines permit health maintenance organizations (HMOs) to offer point-of-service (POS) benefits. Medicare members can now access out-of-network care for an extra fee.
Area of Science:
- Health Policy
- Healthcare Management
Background:
- New Health Care Financing Administration (HCFA) guidelines have been released.
- These guidelines specifically address health maintenance organizations (HMOs) holding Medicare risk contracts.
Purpose of the Study:
- To inform stakeholders about the implications of new HCFA guidelines.
- To highlight the introduction of point-of-service (POS) benefits for Medicare members within HMOs.
Main Methods:
- Analysis of recently issued Health Care Financing Administration (HCFA) guidelines.
- Review of the provisions allowing Medicare risk contract HMOs to offer new benefits.
Main Results:
- Health maintenance organizations (HMOs) with Medicare risk contracts are explicitly permitted to sell a point-of-service (POS) benefit.
- Medicare members enrolled in these HMOs can opt for out-of-network medical services for an additional charge.
Conclusions:
- The new guidelines expand healthcare choices for Medicare beneficiaries in HMOs.
- This policy change allows for greater flexibility in accessing medical services beyond the traditional HMO network.