Which type of plan requires members to have a primary care physician?

A Health Maintenance Organization (HMO) plan is structured to emphasize preventive care while requiring members to select a primary care physician (PCP). This designation is essential because the PCP acts as the coordinator of care, managing and directing the member's healthcare services, including referrals to specialists.

Utilizing a primary care physician helps streamline the process of receiving care and ensures that all aspects of a member's health are monitored and managed effectively. This model is designed to encourage regular check-ups and preventative measures, which ultimately benefits the overall health of the members and helps control costs within the plan by limiting unnecessary specialists or services outside the network, which may not be covered without a referral.

In contrast, other types of plans like Preferred Provider Organizations (PPOs) allow greater flexibility, enabling members to see any doctor without needing a referral, while Medicare Cost Plans and Private Fee-for-Service Plans also provide different structures regarding the management of care, but do not necessitate members to have a primary care physician in the same manner as an HMO.