Medicaid is an assistance program offered by the State to individual having low income and unable to bear the medical expenses on their own. The medical assistance is provided in the form of direct payment to the medical services and sometimes even in cash benefit to some of the eligible individuals.
Medicaid programs are different in each state depending on the population and ratio of person who are below the stipulated poverty line. Some of the services that are covered by the state assisted Medicaid program are prenatal services, maternity services, immunization charges, physician charges, diagnostics, home medical services, X-ray charges etc.
HMO means Health Maintenance Organization that provides health coverage to eligible individuals in the State of Indiana. In a Medicaid HMO plan there is an undertaking between the medical service providers and the HMO to provide medical assistance to individuals from the approved network of hospitals or doctors. Under this Medicaid HMO plan the health maintenance organization receives a fixed amount from the State based on the number of individuals enrolled with them.
This amount is obtained by the HMO even when the individual has not utilized the medical aid every year. This plan decides the amount of medical aid that will be provided to the beneficiary and at times may require the beneficiary to pay some part of the insurance premium apart from the medical aid.
The beneficiaries are eligible for getting paid for all the medical expenses only when the rules stipulated by the HMO are fulfilled. The beneficiary has to ensure that the medical assistance obtained is preapproved by the assigned physician before any amount is paid. It is only when the rules set by the HMO are followed by the beneficiary that they become eligible for getting medical expenses even in a medical emergency situation without fail.