Which term describes a health plan that requires selecting a primary care physician and obtaining referrals for specialists?

• A. Health Maintenance Organization (HMO)
• B. Preferred Provider Organization (PPO)
• C. Point of Service (POS)
• D. Exclusive Provider Organization (EPO)

Answer: (C)

A health plan that uses a primary care physician as the gatekeeper and requires referrals to see specialists is an HMO. This arrangement emphasizes coordinated, in-network care coordinated through a single PCP. You typically pay lower costs, but you must stay within the network and obtain referrals for specialist visits; out-of-network coverage is usually limited or unavailable, except in emergencies.

PPOs let you see specialists without referrals and offer broader network freedom but at higher costs. POS plans mix elements of HMOs and PPOs, often requiring a PCP and referrals for in-network care while allowing limited out-of-network options. EPOs generally require staying in-network and may or may not use a PCP gatekeeper depending on the plan.