What Is a POS Plan?

What Is a POS Plan?

1000 667 Jennifer Nelson

Even if the only time you think about your health insurance choices is during open enrollment, you’re bound to run into HMOs and PPOs on a pretty regular basis. POS plans get less attention. Here’s what you need to know if you encounter them.

What Is a POS Plan?

POS stands for point of service. Like with an HMO, POS plan holders choose a doctor in their network to be their primary care physician (PCP) who coordinates most of their specialist care by referral — which means you’ll need to keep your doctor in the loop if you want to see a specialist.

Like PPOs, POS plans give patients the flexibility to get care outside of their network. But POS plans tend to cost less than PPOs, with smaller monthly premiums as well as lower deductibles and copays for in-network care.

What Else to Do I Need to Know?

Despite the flexibility and savings that come with POS plans, you’ll still pay higher out-of-pocket costs for out-of-network care.
When you leave your network — which may be smaller than a PPO’s — you might also have to pay your bill upfront and then file your own insurance claim after the fact. And if you almost never see specialists, out-of-network coverage might not be as important to you as it is, say, to someone who needs to meet regularly with an oncologist states away while receiving cancer treatments.

Something of a hybrid,
POS plans may be less popular in part because their details can be confusing. It’s a lot to keep track of:
You’ll have to consider how often you see specialists and whether your favored providers are in your network — plus balance the lower premiums and deductibles against the higher out-of-network costs and having to wait for reimbursement. Whatever plan you’re considering, read the details carefully and talk to an insurance broker before enrolling.

Jennifer Nelson

Jennifer Nelson is an award winning health, health IT, and personal finance writer.

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