Point of Service (POS) plans: How this type of insurance works

Should you get a Point of Service (POS) plan?

That’s a good question.

When you’re shopping for health insurance, you’ve got a lot of options, and this is one of them. If you’re wondering what a POS plan is all about, you’re not alone.

So, what’s a POS health plan? 

It’s formally called Point of Service health insurance.¹

Wondering how this type of plan works?

Think of it as a hybrid of traditional health plans like HMO and PPO insurance. We’ll explain more about this in just a bit.

In this article, you’ll learn…

• How POS health insurance works,
• What coverage looks like, and
• What to expect if you choose this type of plan.

Traditional health plans vs. POS health insurance 

Chances are pretty good you’ve heard of traditional-model health plans:

• HMOs: Health Maintenance Organizations.² They’re fixed networks of providers that only provide care within the network. If you get medical care outside the HMO network, you may pay full price, out of pocket.
• PPOs: Preferred Provider Organizations.³ They’re more flexible networks of providers. You’ll pay less for care from an in-network provider. If you go outside the PPO network, you’ll pay more, but the plan usually covers part of the cost.

How is POS health insurance different from traditional plans?

POS health insurance plans include factors from both HMOs and PPOs.

They are a type of managed care that offers coverage for in-network and out-of-network services.

They’re similar to HMOs in that you receive more benefits by staying within the network, but you can still receive some coverage if you go out-of-network, like with PPOs.

POS health insurance: Pros⁴ 

• Pay less in-network. You’ll pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network.
• No in-network referrals required. You can see an in-network provider without a referral. However, POS plans typically require you to get a referral from your primary care doctor in order to see an out-of-network specialist.
• Flexibility to move between in-network providers and out-of-network providers without paying full price out-of-pocket for care

POS health insurance: Cons⁵ 

• Higher rates. POS health insurance plans typically have higher monthly premiums than HMOs. Essentially, you’re paying for a more flexible plan to get care from your choice of providers.
• Primary care physician required. You’ll need to select a primary care doctor who is part of the POS plan. You may have fewer options than doctors participating in HMO and PPO plans.
• More paperwork. POS plans give you more flexibility to see your choice of healthcare providers. However, you’ll also need to manage more of your own paperwork with a POS plan to request a referral, see a specialist, or submit a claim reimbursement.
• Out-of-network deductible. POS plans allow you to see out-of-network providers. But you’ll typically have to meet an out-of-network deductible to access the benefits.

Looking for a POS health insurance plan?

We can help. Call (800) 827-9990 to talk with a licensed insurance agent about your health insurance options and to find out if a POS plan is right for you. Or find a licensed insurance agent in your area to learn more.