Under an HMO plan, which statement is true?

Under an HMO plan, which statement is true?

• A. There are no network restrictions
• B. You must select a PCP
• C. Specialists do not require referrals
• D. You can use out-of-network providers without referrals

Answer: (B)

In an HMO, care is centered around a primary care physician who acts as your gatekeeper, coordinating most of your health services. You choose a PCP, and the plan’s coverage is built around using in-network providers who are connected through that PCP. The PCP referrals are typically required to see specialists, and services are usually not covered if you go outside the network. That gatekeeper role and the emphasis on in-network care explain why selecting a PCP is essential and why it’s the true statement. The other ideas don’t fit because HMOs are network-based plans with limited or no coverage for out-of-network care, except in emergencies. Referrals to specialists are generally required, and using specialists without a PCP-approved referral is not how coverage is designed to work.

In an HMO, care is centered around a primary care physician who acts as your gatekeeper, coordinating most of your health services. You choose a PCP, and the plan’s coverage is built around using in-network providers who are connected through that PCP. The PCP referrals are typically required to see specialists, and services are usually not covered if you go outside the network. That gatekeeper role and the emphasis on in-network care explain why selecting a PCP is essential and why it’s the true statement.

The other ideas don’t fit because HMOs are network-based plans with limited or no coverage for out-of-network care, except in emergencies. Referrals to specialists are generally required, and using specialists without a PCP-approved referral is not how coverage is designed to work.