95.7k views
3 votes
In which plan ( HMO/POS) are out of network benefits available at a higher cost?

User Nayden
by
8.0k points

1 Answer

4 votes

Final answer:

In an HMO plan, out-of-network benefits are generally not available, while in a POS plan, they are available at a higher cost.

Step-by-step explanation:

In an HMO (Health Maintenance Organization) plan, out-of-network benefits are generally not available or are extremely limited. HMOs typically require individuals to choose healthcare providers within a network of contracted healthcare professionals and facilities. If someone requires healthcare services from a provider outside of the network, they would have to pay the full cost of the services themselves.

On the other hand, a POS (Point of Service) plan offers more flexibility when it comes to out-of-network benefits. With a POS plan, individuals have the option to receive care from out-of-network providers, but the benefits may be subject to higher costs. The insurance company will typically cover a portion of the out-of-network costs, but the individual will be responsible for a higher deductible, copayment, or coinsurance.

User Tony Miller
by
8.3k points