What type of plan requires members to obtain referrals for specialists?

The health maintenance organization, or HMO, is the type of plan that requires members to get referrals in order to see specialists. This structure is designed to manage and coordinate care, ensuring that patients receive appropriate services while also controlling costs. When members of an HMO want to see a specialist, they must first consult their primary care physician, who evaluates their condition and determines whether a referral to a specialist is necessary. This approach helps streamline patient care and reduces unnecessary visits, as the primary care physician can ensure that specialist services are warranted.

In contrast, other plan types, such as preferred provider organizations (PPOs) and exclusive provider organizations (EPOs), typically offer members more flexibility in accessing specialty services without needing referrals. Consumer-directed health plans (CDHPs) focus on providing plans with high deductibles coupled with health savings accounts, allowing members to manage their care costs but do not impose referral requirements. Thus, the distinct referral requirement for specialists is a defining characteristic of health maintenance organizations.