Which plan is a hybrid managed care option that requires selecting a primary care provider and obtaining referrals for specialists, often with lower premiums but higher costs for out-of-network care?

• A. HMO
• B. Point of service plan (POS)
• C. Exclusive provider organization (EPO)
• D. Preferred provider organization (PPO)

Answer: (B)

This question centers on how a Point of Service plan works as a hybrid managed care option. In a Point of Service plan you choose a primary care provider who coordinates most of your care. To see specialists, you typically need a referral from that PCP. The plan often offers lower premiums than a PPO, but you’ll pay higher out-of-pocket costs if you use providers outside the plan’s network. This combination— PCP-directed care with referrals, plus some in-network/out-of-network flexibility at a cost trade-off—embodies the hybrid nature of a POS.

Other options don’t fit this description as well. An HMO usually requires a PCP and referrals with little to no out-of-network coverage. An EPO generally requires staying in-network and doesn’t typically involve referrals. A PPO offers more out-of-network freedom and doesn’t require a PCP referral, but it isn’t a hybrid like a POS.