Which of the following statements about HMOs best describes their structure?

• A. They require a primary care physician and referrals for specialists
• B. They allow unrestricted out-of-network care
• C. They require no primary care physician
• D. They provide emergency-only coverage

Answer: (A)

HMOs organize care through a primary care physician who acts as a gatekeeper. You select a PCP who coordinates your overall care, and you need a referral from that PCP to see any specialists. Care is delivered within a defined network, and out-of-network services are typically not covered except in emergencies. This gatekeeping and network-based structure is what sets HMOs apart and explains why the statement about requiring a primary care physician and referrals best describes their setup. Unrestricted out-of-network care is more typical of PPO plans, and HMOs usually require a PCP and do not offer emergency-only coverage.