Which plan type includes out-of-network coverage and requires referrals, but tends to have higher costs?

• A. Blend of HMO and PPO, includes out-of-network coverage, need referrals, higher costs
• B. A plan with no out-of-network coverage
• C. A plan with no referrals required and limited network
• D. A plan offered only to government employees/retirees

Answer: (A)

Understanding plan types and how referrals, networks, and costs interact helps you see why this describes a POS plan. A plan that requires you to obtain referrals for specialists mirrors an HMO, but offering out-of-network coverage and having higher overall costs adds the flexibility of a PPO. This combination is the hallmark of a Point of Service plan: you can see providers outside your network, but you’ll pay more, and you still need referrals for specialist services. The other descriptions fit more one-sided designs—strictly in-network coverage (like an HMO), no referrals with broader network access (like a PPO), or a plan tied to a specific group (government employees)—so they don’t match the given mix of features as well.