Which statement is true about Health Maintenance Organizations (HMOs)?

• A. They generally offer extensive out-of-network coverage
• B. You pay premiums but do not require PCP assignment
• C. They do not require referrals for specialists
• D. You typically need a primary care physician (PCP) and referrals to see specialists

Answer: (D)

In HMOs, access to specialists is controlled through a gatekeeper model: you choose a primary care physician who coordinates most of your care, and you generally need a referral to see any specialist. This setup is designed to manage costs and ensure appropriate, coordinated care. That’s why the statement that you typically need a PCP and referrals to see specialists is true.

The other statements don’t fit with how HMOs work: out-of-network coverage is not extensive in an HMO (they typically cover care only within the network); requiring a PCP is a defining feature (you must have a PCP who manages referrals); and referrals to see specialists are usually required (HMOs use referrals to authorize specialty care).