What’s a POS health plan?
A point of service (POS) plan is a less common type of health insurance that partners with a group of clinics, hospitals and doctors to provide care. With POS insurance, you’ll pay less out of pocket when you get care within that network. Many POS plans require coordination with a primary care provider (PCP) for treatment and referrals. POS health plans may be a good fit for someone who wants flexibility of seeing out-of-network providers (and is comfortable paying more), and who’s already working with a PCP.
These plans are known as point-of-service plans because each time you need health care (the time or “point” of service), you can decide to stay in-network and allow your primary care physician to manage your care, or you can decide to go outside of the network and seek care from a doctor of your choosing.
How does a POS work?
POS plans have similarities to preferred provider organization (PPO) and health maintenance organization (HMO) plans. Like a PPO plan, POS insurance offers the flexibility to see any provider you’d like — but at an added cost. Staying in the plan’s network will help you save money on copays or coinsurance. If you’re willing to spend more, you can head outside the network to get care. The only exception is emergency, which the plan will cover whether it’s in or out-of-network.
When it comes to working with a PCP and referrals, POS plans operate like HMOs. You’ll have to work with a PCP to coordinate your treatment, as well as referrals to see specialists and sometimes for out-of-network providers. For example, if you want to see a dermatologist, your primary care provider will have to submit a referral before you can schedule an appointment.
What’s the advantage of a POS plan?
POS health insurance offers flexibility in provider choice, but may come with some hoops to jump through (like referrals). The 3 biggest advantages of a POS plan are:
- Out-of-network coverage
- More providers to choose from
- If preapprovals are needed, your PCP takes care of them for you
What are the cost considerations with a POS plan?
Typically, POS plan premiums are higher than HMOs, but lower than PPOs. Other cost considerations include things like how much care you or your family might need during the plan year, and how often you might see specialists or out-of-network providers.
What’s the difference between a POS and a PPO plan?
Generally, POS and PPO plans have 2 main differences. Unlike PPO plans, many POS plans require you to choose a PCP to help manage care. And second, many POS plans require referrals to see specialists or some out-of-network providers.
Take time to understand the differences between POS and PPO plans before deciding which to buy.
Compare POS, PPO and HMO plans
| POS | PPO | HMO | |
|---|---|---|---|
How much does it cost? |
Lower monthly premium | Higher monthly premium | Usually lower premiums |
Do I need referrals? |
Yes | No | Yes |
Is there coverage for out-of-network care? |
Yes | Yes | No |
Am I required to choose a primary care provider? |
Yes | No | Yes |
Do I need a referral with a POS plan?
Yes, to schedule an appointment with a specialist, POS plans require a referral from your primary care provider. You may also need a referral for some out-of-network providers.
POS plans are just one of many health insurance options you may be interested in. Research the different plans in your area so you can pick the best type of plan for you and your family