Which term best describes a plan commonly offered by employers that coordinates care through a primary physician?

• A. HMO
• B. Tricare
• C. PPO
• D. Group health insurance

Answer: (A)

Plans that coordinate care through a primary physician are Health Maintenance Organizations. In an HMO, you choose a primary care physician who oversees all your care and makes referrals to specialists when needed. This gatekeeper approach keeps care organized, emphasizes preventive health, and generally keeps costs lower by restricting you to a defined network and requiring referrals for specialist visits. Because care is centered on the PCP within the network, you typically pay less out of pocket but you’ll have less flexibility to see providers outside the plan or to forgo referrals.

Tricare is a military health program rather than a typical employer-offered plan. PPOs offer more flexibility and usually don’t require referrals to see specialists, which can come with higher costs. Group health insurance is a broad term for employer-provided coverage but doesn’t specify the gatekeeper model used to coordinate care.