What type of managed care plan allows insured individuals the choice to go in or out of the network?

Point of Service Plans (POS) combine features of both Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO), allowing insured individuals the flexibility to choose healthcare providers in or out of a specified network. When members utilize providers within the network, they generally pay lower out-of-pocket costs; however, they have the option to seek care outside the network at a higher cost. This flexibility is a defining characteristic of POS plans, making them particularly attractive to those who value the ability to choose their care settings while still benefiting from the cost efficiencies of a managed care model.

In contrast, other types of managed care plans have more restrictive networks or requirements that limit members’ ability to seek care outside designated providers. For instance, HMO plans typically require members to select a primary care physician and obtain referrals for specialist services, while EPO plans do not cover out-of-network care at all, except in emergencies. PPOs, while allowing for out-of-network services, generally have higher associated costs but do not require referrals, which differentiates them from POS plans. Thus, it is the unique blend of flexibility and cost sharing in POS plans that sets them apart and aligns with the question posed.