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All of the following are true abotu preferred provider organizations, except: the plan offers a saving option, which was required by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) Preferred providers include physicians, hospitals, diagnostic facilities, and other service providers Care is managed in the sese that insured people pay less if care is obtained from a network of preferred providers with which the insurer contracts for discounted rates If care is not provided by a preferred provider, the insured individual pays a higher undiscounted rate and must meet higher deductibles and coinsurances for these services

Ask by Morrison Donnelly. in the United States
Mar 20,2025

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The plan offering a saving option required by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) is not a characteristic of PPOs.

Solución

1. First, recall that a preferred provider organization (PPO) is a type of managed care plan that contracts with a network of physicians, hospitals, and diagnostic facilities. 2. PPO plans allow enrollees to obtain care from providers both within and outside the network; however, costs are lower when care is obtained from in-network providers. 3. Option 2 states that preferred providers include physicians, hospitals, and diagnostic facilities. This is true. 4. Option 3 explains that care is managed in the sense that insured people pay less when they use network providers contracted with the insurer for discounted rates. This is also true. 5. Option 4 indicates that if care is obtained outside the network, the insured individual pays a higher rate and must meet higher deductibles and coinsurances, which aligns with the common structure of PPO plans and is correct. 6. Option 1 mentions that the plan offers a saving option required by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). This statement is not an inherent characteristic of PPO plans – the MMA pertains to Medicare prescription drug benefits, not the fundamental features of a PPO plan. Thus, the exception—the statement that is not true about PPOs—is: \( \textbf{the plan offers a saving option, which was required by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA)} \).

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Extra Insights

Preferred Provider Organizations (PPOs) are often celebrated for their flexibility; members can see any doctor or specialist without needing a referral, making it easier to get the care they want, when they want it. However, keeping an eye on those out-of-network costs is crucial because that's where things can get pricey! When enrolling in a PPO, many people mistakenly assume they’ll always save money by going out of network. In reality, this could lead to unexpected bills because those higher deductibles and coinsurance can really add up. So, remember to check if your provider is in the network for a smoother, cost-effective experience!

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