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In the United States, an exclusive provider organization (EPO) is a hybrid health insurance plan in which a primary care provider is not necessary, but health care providers must be seen within a predetermined network. Out-of-network care is not provided, and visits require pre-authorization.
Unlike EPO members, however, PPO members are reimbursed for using medical care providers outside of their network of designated doctors and hospitals. However, when they use out-of-network providers PPO members are reimbursed at a reduced rate that may include higher deductibles and co-payments, lower reimbursement percentages, or a combination ...
The earliest form of HMOs can be seen in a number of "prepaid health plans". In 1910, the Western Clinic in Tacoma, Washington offered lumber mill owners and their employees certain medical services from its providers for a premium of $0.50 per member per month.
Medicare is a federal health insurance program designed for people aged 65+ and older, as well as younger individuals with certain disabilities or medical conditions. More than 66 million people ...
The Centers for Medicare and Medicaid Services (CMS) administers Medicare. In 2022, 65.1 million Americans had Medicare, and 3.9 million of those were new beneficiaries.. Medicare has four parts ...
HRAs are treated as group health plans and subject to the Medicare secondary payment (MSP). HRAs are subject to the provisions regardless of whether or not they have an end-of-year carry-over feature. Standalone HRAs not offered in conjunction with a High Deductible Health Plan are subjected to restrictions starting in 2014. [19]