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

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

• A. Preferred Provider Organization (PPO) plan
• B. Point of Service (POS) plan
• C. Private Fee-for-Service (PFFS) plan
• D. Health Maintenance Organization (HMO) plan

Answer: (B)

A Point of Service (POS) plan is a type of managed care plan that combines features of Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. In a POS plan, members are generally required to choose a primary care physician (similar to an HMO) and get referrals for specialists. However, what distinguishes a POS plan is its flexibility in allowing members to seek out-of-network services at a higher cost. This structure provides a balance for individuals who prefer the cost savings typically associated with HMO plans but also want the option to access services from providers outside of the plan's network, albeit at a higher out-of-pocket expense. This flexibility can be appealing for members who might need specialists or services not available within the network. In contrast, an HMO plan typically does not cover out-of-network benefits, while a PPO plan allows out-of-network access but generally does not require members to choose a primary care physician or get referrals. A Private Fee-for-Service (PFFS) plan also allows members to see any provider who accepts the plan's payment terms but does not necessarily require a primary care physician or referrals like a POS plan does.

A Point of Service (POS) plan is a type of managed care plan that combines features of Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. In a POS plan, members are generally required to choose a primary care physician (similar to an HMO) and get referrals for specialists. However, what distinguishes a POS plan is its flexibility in allowing members to seek out-of-network services at a higher cost.

This structure provides a balance for individuals who prefer the cost savings typically associated with HMO plans but also want the option to access services from providers outside of the plan's network, albeit at a higher out-of-pocket expense. This flexibility can be appealing for members who might need specialists or services not available within the network.

In contrast, an HMO plan typically does not cover out-of-network benefits, while a PPO plan allows out-of-network access but generally does not require members to choose a primary care physician or get referrals. A Private Fee-for-Service (PFFS) plan also allows members to see any provider who accepts the plan's payment terms but does not necessarily require a primary care physician or referrals like a POS plan does.