AHIP Practice Exam

Health Maintenance Organizations (HMOs) are structured to provide a range of health care services to their members while focusing on preventive care. This typically includes services such as preventive screenings and vaccinations, primary care services for general health maintenance, and diagnostic tests to identify health issues early on.

The design of HMO plans generally requires members to choose a primary care physician (PCP) who acts as a gatekeeper, managing all aspects of care, including referrals to specialists. This means that visits to specialists typically require a referral from the PCP. Therefore, specialist visits without a referral are not commonly included in HMO coverage, as the model emphasizes coordinated care through a primary care provider who oversees the patient’s overall health. This approach is intended to keep health care costs lower and ensure that care is provided in a streamlined manner.