Which plan is typically described as having enrollment through a network of providers with care coordinated by a gatekeeper?

• A. HMO
• B. PPO
• C. EPO
• D. POS

Answer: (A)

This describes a plan where enrollment happens through a fixed network of providers and a primary care physician acts as a gatekeeper who coordinates all care. This gatekeeper model is the hallmark of a Health Maintenance Organization (HMO). The PCP is responsible for guiding you to appropriate services and requires referrals for specialty care, which helps control costs and ensure coordinated, continuous care. Benefits typically cover in-network services first, with limited or no coverage for out-of-network care except in emergencies.

PPOs, by contrast, usually don’t require a gatekeeper and let you see any provider, though in-network care is cheaper and out-of-network options cost more. EPOs are network-based like HMOs but generally don’t provide benefits outside the network. POS plans blend features of HMOs and PPOs, often requiring a PCP and referrals but allowing some out-of-network visit options at higher costs.