Fill in the blank: __________________ are health insurance plans that will generally only pay for services performed by providers within their network.

Prepare for the Get Covered Illinois Test. Study with detailed multiple-choice questions and hints with answers for each question. Boost your confidence and get ready for your exam!

Health Maintenance Organizations (HMOs) are designed to provide health insurance coverage primarily through a network of doctors, hospitals, and other healthcare providers. The defining characteristic of HMOs is that they typically require members to choose a primary care physician (PCP) and obtain referrals from that PCP to see specialists. This structure encourages coordination of care and often results in lower costs for members, as services rendered by providers outside the network may not be covered or are covered at a much lower rate.

In contrast, Preferred Provider Organizations (PPOs) offer more flexibility in choosing providers and do not require a primary care physician or referrals for specialists, which distinguishes them from HMOs. Qualified Hospital Plans refer to coverage that meets specific criteria set by the Affordable Care Act but do not inherently have the network limitations that are characteristic of HMOs. The Health Insurance Marketplace is a platform where individuals can compare and purchase insurance plans, which can include various types of plans like HMOs, PPOs, and others, but is not itself a type of plan.

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