Medical Expense✓ Verified · outline & fact-checked · Sep 2026Difficulty 2/5
A point-of-service (POS) plan combines features of an HMO and a PPO. Which statement correctly describes how a POS plan works?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
A point-of-service (POS) plan is the hybrid of HMO and PPO features: the member selects a primary care physician who serves as the gatekeeper for in-network care (specialists generally require a referral), but unlike a pure HMO, the member may go outside the network without a referral and receive coverage at a higher level of cost-sharing, such as a separate deductible and higher coinsurance. The exam tests POS as the plan type that keeps the HMO gatekeeper for in-network care while adding limited out-of-network flexibility at the member's expense.
Why the other options are wrong
- B) No standard plan type pays all care at the same level with no PCP selection; that combination describes no plan model, and POS specifically requires a primary care physician for in-network care.
- C) POS plans do cover out-of-network care, but at higher cost-sharing; excluding out-of-network care entirely is a feature of an EPO, not a POS plan.
- D) POS plans are commercial products, not Medicare plans; they require no Medicare approval for covered services.
Memory hook
POS = PCP at home, freedom abroad. In network, follow the gatekeeper; out of network, pay the toll.