Tanya's health care plan allows her to see any specialist with a referral, but incurs higher costs if the specialist is out of the network. What type of plan does she have?

The type of health care plan that Tanya has is a Point of Service (POS) plan. This plan combines features of both Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). In a POS plan, individuals are encouraged to choose a primary care physician (PCP) and need a referral to see specialists. This referral process ensures coordinated care. However, like a PPO, patients also have the flexibility to see out-of-network specialists, but at a higher cost, which aligns perfectly with the description of Tanya’s situation.

This structure allows the plan to maintain a network of providers while still offering the option of out-of-network care. Understanding these details is essential for recognizing how different health care plans operate, specifically regarding referrals and cost implications for in-network versus out-of-network services.