Which statement describes a Health Maintenance Organization (HMO)?

• A. A plan requiring members to use in-network providers and get referrals.
• B. A plan allowing out-of-network visits with no referrals.
• C. A plan that charges premium for private rooms.
• D. A plan that covers only dental and vision.

Answer: (A)

A Health Maintenance Organization (HMO) is designed around coordinated, network-based care managed through a primary care physician. You pick a PCP who coordinates your services and provides referrals to specialists. Because of this structure, you generally must use in-network providers, and you typically won’t have coverage for services from out-of-network providers except in emergencies. HMOs often have lower premiums and less flexibility in choosing providers, reflecting their emphasis on cost control and preventive care. The other statements describe different plan features (such as plans that allow out-of-network visits, charge for private-room accommodations, or cover only dental/vision) and don’t fit the defining structure of an HMO.