Commission for Case Manager Certification (CCMC) Exam 2025 – 400 Free Practice Questions to Pass the Exam

A Health Maintenance Organization (HMO) is characterized by its requirement for members to use a network of specific healthcare providers. This network typically consists of primary care physicians and specialists who have contractual agreements with the HMO. The structure is designed to provide comprehensive services while managing costs. By requiring members to seek care primarily from in-network providers, HMOs can negotiate better rates with those providers, offering lower premiums and out-of-pocket costs for services rendered to their members. This model emphasizes preventive care and a managed approach to healthcare delivery, aligning with the overall goals of cost containment and patient health maintenance.

Other types of health plans might not have such stringent network restrictions or may allow for coverage without referrals, which is not the case for HMOs, where referrals from primary care providers to specialists are typically required.