What distinguishes Preferred Provider Organizations (PPO) from Health Maintenance Organizations (HMO)?

The distinction between Preferred Provider Organizations (PPO) and Health Maintenance Organizations (HMO) is particularly highlighted by the requirement of a primary care physician. In a PPO plan, enrollees are not required to select a primary care physician or obtain a referral to see a specialist. This flexibility allows members to visit any healthcare provider, both in and out-of-network, without needing prior authorization. This feature is essential for individuals who prefer more autonomy over their healthcare choices and don’t want the restrictions associated with a primary care gatekeeper model typically seen in HMOs.

In contrast, HMOs generally require members to choose a primary care physician, who acts as a gatekeeper to provide referrals for specialists and other healthcare services. This referral process is designed to manage healthcare costs and coordinate care among providers.

Given this fundamental aspect of how PPOs operate, the option that states they do not require a primary care physician accurately represents an important characteristic that sets them apart from HMOs.