Which statement correctly describes a Point-of-Service (POS) plan and how it blends features of HMO and PPO plans?

• A. POS plans are identical to HMOs and require referrals but do not offer any out-of-network coverage.
• B. POS plans are equivalent to PPOs with no gatekeeper and full out-of-network coverage.
• C. POS plans require an in-network gatekeeper and referrals like an HMO, but may offer some out-of-network coverage with higher cost-sharing.
• D. POS plans never cover out-of-network costs under any circumstances.

Answer: (C)

Point-of-Service plans blend gatekeeper control with optional out-of-network access. You typically choose a primary care physician and need referrals to see specialists, like an HMO. But unlike a pure HMO, a POS plan also lets you go outside the network and receive care, though with higher cost-sharing and often more limited coverage. This combination is why it’s described as a hybrid: you get the lower costs and coordinated care when staying in-network, and you have the option to go out-of-network at a higher cost. The other descriptions don’t fit because HMOs usually offer little to no out-of-network coverage, and PPOs generally avoid gatekeepers while providing broader out-of-network coverage with lower referrals barriers.