Final answer:
A hybrid between an HMO and a PPO is a Point-of-Service (POS) plan. This plan offers both structured care and the flexibility to see out-of-network providers. Adverse selection is a key consideration for insurers within POS plans.
Step-by-step explanation:
The hybrid health plan that combines elements from both Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) is known as Point-of-Service (POS) plans. In this type of plan, healthcare providers receive reimbursement to some degree similarly to HMOs, based on patient enrollment, but patients also have the flexibility to use out-of-network providers, typically at a higher out-of-pocket cost, similar to PPOs. This model offers a balance of structured care with flexibility, which may come with higher copays or co-insurance when stepping out of the established network. Adverse selection is a concern for insurers within these plans, as high-risk individuals may be more likely to opt-in for the comprehensive coverage, potentially leading to higher costs for the insurer.
As for the demographic that would be offered a policy with a high copay: insurers may present such options to individuals seen as higher risk or those who prefer to have lower monthly premiums but can handle higher costs when receiving care. On the other hand, a high premium plan with a lower copay would be more appealing to individuals who regularly require medical services and are willing to pay more on a monthly basis to reduce costs at the time of service