1. A managed-care plan combining HMO-style network care with the option to go out of network at higher cost is a:

Point-of-service (POS) plan

A POS plan blends HMO features with the option to use out-of-network providers at higher cost sharing.

2. In a traditional HMO, access to a specialist usually requires:

A referral from the primary care physician

Traditional HMOs use the primary care physician as a gatekeeper who must refer members to specialists.

3. Paying a provider a fixed amount per member per month regardless of services used is called:

Capitation

Capitation pays providers a set amount per member per month regardless of the volume of services delivered.

4. Many ACA-compliant plans cover certain preventive services:

With no cost sharing when received in network

ACA-compliant plans generally cover designated preventive services in network with no cost sharing to the member.