PSI Ohio Insurance Practice Exam

How does a Health Maintenance Organization (HMO) differ from a traditional insurer?

1. Provides unlimited coverage for all services.

2. Manages care through a primary care physician.

3. Offers worldwide coverage on all policies.

4. Has no restrictions on specialist visits.

The correct answer is: Manages care through a primary care physician.

A Health Maintenance Organization (HMO) is designed to deliver comprehensive health care services to its members while controlling costs and improving care management. One of the key features of an HMO is that it requires members to select a primary care physician (PCP). The primary care physician acts as a gatekeeper responsible for managing the patient's overall care, coordinating referrals to specialists, and ensuring that the patient receives appropriate services. This structure allows HMOs to efficiently manage their resources and ensure that care is provided in a more organized manner, focusing on preventive care and reducing unnecessary specialist visits or tests. By having a primary care provider oversee care, HMOs aim to improve health outcomes and reduce costs associated with fragmented care. In contrast, traditional insurers may allow more flexibility in choosing specialists and generally do not require a PCP for every service. Therefore, the primary care physician's role in managing care is a distinctive characteristic of HMOs that sets them apart from traditional insurers.