What is a key requirement of HMO plans regarding specialist visits?

HMO plans, or Health Maintenance Organization plans, are structured to emphasize preventive care and manage costs effectively. A key requirement of HMO plans is that members must utilize a network of providers and obtain referrals from their primary care physician to see a specialist. This requirement helps ensure coordinated care, as the primary care physician acts as a gatekeeper who evaluates the patient’s health issues and determines whether specialized treatment is necessary.

Additionally, requiring referrals allows HMOs to maintain lower costs by managing the utilization of specialized services, which can be more expensive. This structure promotes an integrated approach to healthcare, ensuring that all aspects of a member's care are coordinated through their selected primary care provider. In this context, the necessity of a referral for specialist visits is an essential characteristic that differentiates HMO plans from other types of health insurance plans, like PPOs, where members generally have more freedom to see specialists without needing referrals.