Covered California Certified Enroller Practice Exam

What is a key characteristic of HMOs concerning member care?

1. Members can freely choose any specialist

2. Members are required to select a PCP

3. All services are available without any restrictions

4. Emergency care does not require a referral

The correct answer is: Members are required to select a PCP

A key characteristic of Health Maintenance Organizations (HMOs) is that members are required to select a primary care physician (PCP). This requirement establishes a centralized point of access for healthcare services, ensuring that the member receives coordinated care. The PCP plays a crucial role in managing the patient's overall health, providing preventive care, and making referrals to specialists when necessary. This model promotes a structured approach to healthcare, encouraging members to engage with their PCP first, which can lead to better health outcomes and efficient use of healthcare resources. In the context of HMOs, the other options do not align with this model. For instance, while emergency care does not typically require a referral, this is more common in other types of plans, like PPOs. Additionally, members of HMOs do not have the freedom to choose any specialist without going through their PCP first, emphasizing the structured pathway of care that is part of the HMO system. Therefore, the requirement to choose a PCP is fundamental to how HMOs operate and contributes to their cost-effective and coordinated approach to health management.