Which plan provides coverage through a network of selected providers but may require higher costs for care received outside the network?

Which plan provides coverage through a network of selected providers but may require higher costs for care received outside the network?

• A. POS
• B. PPO
• C. EPO
• D. HMO

Answer: (B)

Understanding how a PPO works. A Preferred Provider Organization provides coverage through a network of selected providers at negotiated rates, so you pay the lowest costs by staying in-network. You can still receive care outside the network, but at higher out-of-pocket costs and often with lower reimbursement from the plan. This flexibility—network-based coverage with the option to go out-of-network at a higher cost—is the feature described in the question. By contrast, other plans typically restrict or eliminate out-of-network coverage (EPO), require a primary care physician and referrals with limited out-of-network options (HMO), or blend features with different referral rules (POS), which doesn’t fit as neatly as the PPO description.

Understanding how a PPO works. A Preferred Provider Organization provides coverage through a network of selected providers at negotiated rates, so you pay the lowest costs by staying in-network. You can still receive care outside the network, but at higher out-of-pocket costs and often with lower reimbursement from the plan. This flexibility—network-based coverage with the option to go out-of-network at a higher cost—is the feature described in the question. By contrast, other plans typically restrict or eliminate out-of-network coverage (EPO), require a primary care physician and referrals with limited out-of-network options (HMO), or blend features with different referral rules (POS), which doesn’t fit as neatly as the PPO description.