What best describes Independent Health Plans like HMO and PPO?

• A. Subscribers must pay full price and have no network restrictions.
• B. Providers are not contracted with the insurer and charges are unregulated.
• C. Subscribers use contracted providers at lower cost and gatekeepers manage access.
• D. They do not aim to control costs or utilization.

Answer: (C)

These plans are managed care networks where providers contract with the insurer to deliver services at discounted, negotiated rates. A primary care physician or gatekeeper coordinates care, approving referrals to specialists and overseeing tests and hospitalizations to prevent unnecessary services. The combination of using a contracted network at lower costs and having a gatekeeper manage access is what defines how plans like HMO and PPO operate.

Why this is the best description: the discount from negotiated provider rates lowers out-of-pocket costs, and gatekeeping keeps utilization in check by ensuring care is appropriate and coordinated.

Why the other ideas don’t fit: these plans rely on a network with negotiated rates, not full-price care with no restrictions; they involve contracted providers and cost controls, not unregulated charges; and they are designed to curb costs and utilization, not to ignore them.