CMAA Practice Exam 2026 – Complete Guide for Exam Prep

The correct answer is Health maintenance organization (HMO). In an HMO, patients are required to select a primary care physician (PCP) and obtain referrals from this PCP to see specialists. For services to be covered under an HMO, patients must use the network of participating providers. This structure is designed to promote coordinated care and preventive services, which can help manage costs and improve health outcomes.

In contrast, while other managed care plans allow for some flexibility regarding provider choices, they typically do not mandate that patients exclusively use participating providers for coverage. For example, a preferred provider organization (PPO) offers the option to see both in-network and out-of-network providers, albeit with different cost-sharing arrangements. A point of service (POS) plan combines features of HMOs and PPOs, allowing patients to choose between in-network and out-of-network care, but it still operates under a referral system. An exclusive provider organization (EPO) requires members to use their network for coverage, but it gives more flexibility than an HMO when it comes to seeing specialists without a referral.

This structured approach of requiring patients to obtain care from designated providers is fundamental to how HMOs function, ensuring that the care provided aligns with the network's goals of health