Which statement correctly describes an open-access HMO?

Why D is correct

An open-access HMO is a variation of the HMO model that lets members visit participating network specialists directly, without a referral from a primary care physician. It preserves the network and managed care structure of an HMO while removing the gatekeeper referral step for in-network specialty care. The traditional HMO gatekeeper/referral model still exists, but open-access plans trade that control for member convenience, usually while keeping out-of-network coverage limited or absent. The open-access design removes the referral bottleneck for network specialists while preserving the HMO's network-based, cost-managed structure. Members still generally receive covered care from participating providers, and out-of-network coverage remains limited compared with a PPO.

Why the other options are wrong

• A) Requiring a gatekeeper referral for every specialist visit describes the traditional HMO model, not an open-access HMO. Requiring a gatekeeper referral for every specialist describes the traditional or closed-panel HMO, while the open-access model is defined by removing that referral step for network specialists.
• B) Open-access HMOs typically do not provide broad out-of-network coverage; the open access applies to in-network specialists. Open-access HMOs still operate within a network and do not generally provide out-of-network care at in-network cost sharing; that symmetry is the hallmark of a PPO, not an open-access HMO.
• C) An open-access HMO still operates within a physician network; it is not an indemnity arrangement that reimburses any provider. An open-access HMO is a managed care plan with a defined network of participating providers; indemnity plans that reimburse any provider without a network are a different product category.

Memory hook

Open-access HMO = see the network specialist directly, no gatekeeper permission slip.