North Carolina Health Insurance Practice Exam

A Preferred Provider Organization (PPO) plan allows members to see any doctor without needing a referral. This feature provides significant flexibility for members to choose their healthcare providers. In a PPO, participants typically pay less if they use healthcare providers in the plan's network, but they still have the option to visit out-of-network providers, often at a higher cost. This structure is designed to give members more control over their healthcare decisions, allowing them to manage their needs based on personal preferences rather than being restricted by a primary care physician or a requirement for referrals.

In contrast, other plans typically have referral requirements. For example, Health Maintenance Organizations (HMOs) require members to select a primary care physician (PCP) who coordinates all care and provides referrals for specialists. Exclusive Provider Organizations (EPOs) also limit coverage to providers within their network, though they may allow for some flexibility without needing referrals, but not to the same extent as PPOs. Point of Service (POS) plans combine features of HMOs and PPOs, often requiring referrals for out-of-network care, which contrasts with the freedom of access that PPOs offer.