Which plan is described as network-based with a gatekeeper physician coordinating care within the network?

Which plan is described as network-based with a gatekeeper physician coordinating care within the network?

• A. HMO
• B. PPO
• C. EPO
• D. POS

Answer: (A)

The plan described is a Health Maintenance Organization. In an HMO, care is provided through a defined network, and a primary care physician acts as a gatekeeper who coordinates all your care within that network. You choose a PCP, and most specialist visits require a referral from that physician. Coverage is generally limited to in-network providers, with out-of-network care (except emergencies) typically not covered. This gatekeeper model—network confinement plus the PCP coordinating referrals—is what distinguishes HMOs from other plan types.

The plan described is a Health Maintenance Organization. In an HMO, care is provided through a defined network, and a primary care physician acts as a gatekeeper who coordinates all your care within that network. You choose a PCP, and most specialist visits require a referral from that physician. Coverage is generally limited to in-network providers, with out-of-network care (except emergencies) typically not covered. This gatekeeper model—network confinement plus the PCP coordinating referrals—is what distinguishes HMOs from other plan types.