A Point-of-Service (POS) plan is best described as:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
A POS plan blends HMO and PPO features. Like an HMO, it requires the member to select a primary care physician who coordinates care, and in-network specialist visits generally need a referral from that physician. Like a PPO, however, the plan allows members to go outside the network at the point of service, paying higher deductibles, coinsurance, and copays for out-of-network care. This 'choice at the point of service' is what gives the plan its name and is the classic exam distinction between the POS plan and the stricter HMO, which generally offers no out-of-network benefit.
Why the other options are wrong
- B) No standard plan pays 100% of out-of-network care with no deductible. In a POS plan, out-of-network care is covered only at a reduced benefit level with higher cost sharing than in-network care.
- C) A POS plan does require a primary care physician and referrals for in-network specialists. That gatekeeper structure distinguishes it from a pure PPO, where members generally see specialists directly without referrals.
- D) POS plans are sold in the commercial individual and group markets to all eligible enrollees. They are not restricted to Medicare beneficiaries, who have their own separate Part C options.
Memory hook
POS = PCP gatekeeper inside, freedom outside. You choose where at the point of service.