Which plan type generally allows out-of-network coverage with higher costs?

• A. HMO
• B. EPO
• C. PPO
• D. POS

Answer: (D)

Point of Service plans blend features of managed care by offering some out-of-network access while keeping cost controls in place. You typically choose a primary care physician and need referrals to see specialists, which helps manage expenses. If you stay in-network you pay lower costs, but you can go out-of-network and still be covered, though at a higher cost share (larger deductibles, higher coinsurance or co-pays, and sometimes balance-billing). That combination—network-based access with a referral requirement, plus out-of-network coverage that comes with higher costs—best fits the description. In comparison, HMOs usually offer little to no out-of-network coverage; EPOs restrict to network with no out-of-network option; PPOs allow out-of-network care with higher costs but typically don’t require a PCP referral.