Medical Expense✓ Verified · outline & fact-checked · Sep 2026Difficulty 1/5
Which feature is characteristic of an HMO (health maintenance organization) plan?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
The HMO model centers on a primary care physician who acts as a gatekeeper: the member selects a PCP, and specialty care generally requires a referral through that physician. This care coordination is how HMOs control costs and utilization. Benefits are typically available only within the HMO's provider network.
Why the other options are wrong
- B) 'Same level of benefits in and out of network' describes no standard plan type — a PPO allows out-of-network access without a referral but typically at higher out-of-pocket cost; HMOs generally do not cover out-of-network care except emergencies.
- C) HMOs generally do not pay for out-of-network care except emergencies and other limited situations, and never at the same cost as in-network.
- D) Selecting a primary care physician is a defining requirement of an HMO, not an optional feature.
Memory hook
HMO = your PCP is the gatekeeper; no referral, no specialist. Network walls are high but premiums are lower.