Which type of health insurance plan typically requires referrals to see specialists?

Health Maintenance Organizations (HMOs) typically require referrals to see specialists, which is a fundamental aspect of how they are structured. In an HMO plan, members are generally required to select a primary care physician (PCP) who serves as a gatekeeper to coordinate their healthcare. This PCP is responsible for providing initial care and making referrals to specialists when more specialized treatment is necessary.

This system is designed to manage care efficiently and often at a lower cost, but it also means that members must go through their PCP to access specialized services. This referral process helps streamline treatment and maintain oversight of patient care, which can be beneficial for both cost management and continuity of care.

In contrast, other types of plans, such as PPOs (Preferred Provider Organizations), typically allow members to see specialists without needing a referral, providing more flexibility in choosing healthcare providers. Fee-for-service (FFS) models offer a pay-per-visit structure without referral requirements, and catastrophic plans focus on covering emergency care and high-cost situations rather than routine care management.