Which term describes a plan that blends features of HMO and PPO, allowing out-of-network coverage with higher costs?

• A. Exclusive Provider Organization (EPO)
• B. Health Maintenance Organization (HMO)
• C. Point-of-Service (POS)
• D. Preferred Provider Organization (PPO)

Answer: (C)

A plan that blends features of HMO and PPO while allowing out-of-network coverage with higher costs is a Point-of-Service plan. It mixes typical HMO characteristics—like having a primary care physician who coordinates care and often requiring referrals for specialists—with the flexibility of a PPO, where you can go outside the network if you’re willing to pay more out of pocket. In-network care usually comes with lower costs and more predictable coverage, while out-of-network visits are available but carried at higher copays/coinsurance and with less favorable coverage. This hybrid setup is what distinguishes it from the other types: an EPO generally limits you to in-network providers with little to no out-of-network coverage; an HMO keeps you strictly in-network with gatekeeping; a PPO typically doesn’t require referrals and emphasizes network flexibility without a PCP gatekeeper.