What is a key feature of Health Maintenance Organizations (HMO)?

Health Maintenance Organizations (HMOs) are characterized by their requirement for members to use healthcare providers that are part of their network to receive coverage for services. This model promotes a more controlled healthcare environment and often results in lower costs for both the organization and the members. The emphasis on utilizing in-network providers helps maintain a streamlined patient care process and promotes preventive care services.

Members typically select a primary care physician from the network, who coordinates any necessary referrals to specialists. Because of this structure, patients who choose to receive care from out-of-network providers usually face significantly higher out-of-pocket expenses or may not have their services covered at all. This requirement helps to manage costs for the HMO and encourages patients to engage with the network for comprehensive healthcare solutions.

In contrast, other options do not align with the foundational operating principles of HMOs. For instance, selecting specialists without a referral contradicts the managed care model of HMOs, which emphasizes the role of primary care physicians in directing patient care. Similarly, the notion of out-of-network benefits contradicts the insurance design inherent to HMOs focused on in-network care. Finally, the unrestricted selection of any primary care physician is not consistent with the HMO model, as members typically choose from a defined network of providers