Which statement about a Health Maintenance Organization (HMO) is true?

• A. It requires no primary care physician
• B. It allows unlimited out-of-network coverage
• C. It requires a designated PCP and authorization to see specialists
• D. It has no referral requirements

Answer: (C)

In an HMO, care is organized through a designated primary care physician who acts as the gatekeeper for your medical services. You choose a PCP, and for most conditions you’ll start with that doctor. To see a specialist, your PCP must evaluate you first and then provide a referral; the plan typically requires this prior authorization before the specialist visit or procedures are approved. This structure keeps care coordinated within the network and helps manage costs.

That gatekeeper and referral requirement is why statements about having no PCP, unlimited out-of-network coverage, or no referral rules don’t fit an HMO. If you stay within the network and follow the referral process, you’re covered as designed; going out of network or skipping referrals generally isn’t covered. For example, needing a cardiologist visit would first go through your PCP, who would refer you to an in-network specialist and obtain the necessary authorization.