Which type of MA Plan is an HMO that covers some benefits out-of-network but generally at a higher cost?

The Point-of-Service (POS) Plan is a type of Medicare Advantage (MA) Plan that combines elements of both Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). These plans typically require members to select a primary care physician and get referrals to see specialists, similar to an HMO. However, one distinct feature of a POS plan is that it offers some coverage for out-of-network services, albeit usually at a higher cost compared to in-network services.

This characteristic makes the POS plan flexible in terms of provider options, allowing beneficiaries to seek care outside their selected network if necessary, which is particularly useful for those who may need to see specific specialists or receive care in less common circumstances. Moreover, while accessing out-of-network healthcare can incur additional expenses, members still have the option, which distinguishes POS plans from traditional HMOs that have stricter limitations on out-of-network care.

In contrast, the other types of plans listed do not align with this specific combination of features. For instance, the Private Fee-for-Service (PFFS) plan generally allows members to see any Medicare-approved provider without requiring a primary care physician. Medicare Supplement Insurance Plans are designed to fill gaps in Original Medicare coverage, without providing the structured network of the