Which type of coverage typically requires a primary care physician referral for specialist services?

Health Maintenance Organizations (HMOs) are designed to provide a structured approach to healthcare that emphasizes preventive care and coordinated treatment. One of the defining features of HMO plans is the requirement for members to select a primary care physician (PCP). This PCP acts as a gatekeeper to the healthcare system, meaning that in order to see a specialist, a referral from the PCP is usually necessary.

This structure helps streamline care and ensure that patients receive appropriate treatments while reducing unnecessary specialist visits and healthcare costs. The goal is to promote an integrated care process where the primary care physician oversees the patient’s overall health and coordinates any specialized treatment that may be required.

In contrast, other types of plans such as PPOs and EPOs typically allow members to see specialists without a referral, offering more flexibility in choosing healthcare providers. Individual health insurance plans vary widely and may or may not have referral requirements, depending on the specific plan design. Thus, the requirement for a PCP referral is a key characteristic of HMOs, making it the correct answer to the question regarding coverage types.