Which statement correctly describes an HMO?

• A. It requires a primary care physician and uses in-network providers with referrals
• B. It allows out-of-network coverage with no referrals
• C. It does not require a PCP
• D. It covers only emergency services

Answer: (A)

In an HMO, care is coordinated through a primary care physician who acts as your gatekeeper. You select a PCP, and most services must come from providers within the plan’s network. If you need to see a specialist, your PCP must give you a referral before the visit. This structure keeps costs predictable and encourages coordinated care, which is a core feature of HMOs.

The statement that best describes this arrangement is that it requires a primary care physician and uses in-network providers with referrals. That captures the gatekeeper role of the PCP, the emphasis on in-network care, and the referral process for specialists.

The other statements don’t fit an HMO: out-of-network coverage with no referrals is more characteristic of a PPO; not requiring a PCP contradicts the gatekeeper model; and covering only emergency services doesn’t reflect how HMOs operate when you stay in-network.