What is the main difference between HMO and POS plans regarding referrals?

The main difference between HMO (Health Maintenance Organization) and POS (Point of Service) plans regarding referrals lies in the flexibility of accessing care and the processes involved in doing so. POS plans are designed to provide members with the option of seeking care both in-network and out-of-network. However, when members choose to see out-of-network providers, they typically do not need to obtain a referral from a primary care provider, which empowers them with more autonomy in choosing specialists and seeking care without prior approval.

In contrast, HMO plans usually require members to select a primary care physician (PCP) and obtain referrals before seeing specialists or receiving certain types of care. This structure is intended to manage costs and ensure that care is coordinated through the PCP.

The other options do not fully capture the nuances of how referrals work in these plan types. For instance, PPO (Preferred Provider Organization) plans generally offer more flexibility than both HMOs and POS plans, allowing members to see any provider without needing a referral, which is not relevant to the distinction between HMOs and POS. Thus, option D accurately reflects the capability of POS plans to allow for out-of-network visits without requiring referrals, marking a significant differentiation in how flexibility in care access is managed.