POS Health Insurance Plans
Everyone needs health insurance to cover them during emergencies or when unexpected medical costs arise. However, it’s also best to have insurance for routine healthcare services like checkups and prescriptions. Unfortunately, there are so many options available to individuals and their families that it can be difficult to choose which type of plan is best for you.
Between HMOs, PPOs, and POS health insurance plans, you may not know what’s the best option based on your budget and existing health concerns.
Finding the right insurance plan for your needs is key to ensuring you’re covered when you require medical care. Since medical costs and insurance premiums rise each year, it can seem daunting to try to find a plan that keeps your family covered.
Luckily, we’re here to help. This article will answer “what is a POS health insurance plan?” and compare them to other common types of coverage to help you choose the right insurance option for you and your loved ones.
What is the meaning of POS in insurance?
POS stands for “point of service,” which refers to the provider of the healthcare services. They’re called point-of-service insurance plans because at each point you need healthcare services, you can decide whether or not to stay in the network. With this type of insurance, your costs all depend on that “point” of service, referring to the healthcare provider or medical facility.
What is POS health insurance?
A Point of Service (POS) plan has some of the qualities of HMO and PPO plans with benefit levels varying depending on whether you receive your care in or out of the health insurance company's network of providers.
How does a POS plan work?
POS plans combine elements of both HMO and PPO plans. Like an HMO plan, you may have to designate a primary care physician who will then make referrals to network specialists when needed.
Depending on the plan you have, services provided by your primary care physician (PCP) are typically not subject to a deductible and preventive care benefits are usually included.
Like a PPO plan, you may receive care from non-network providers but with higher out-of-pocket expenses. You may also be responsible for co-payments, coinsurance, and an annual deductible.
What is POS vs. PPO vs. HMO?
Now that you know a little bit about POS insurance plans, you might wonder what your other options are.
When choosing an individual healthcare plan, you can choose between a POS, PPO, or HMO. They all offer benefits, and the more you’re willing to pay in monthly premiums, the more coverage, and flexibility you’ll likely have.
Here’s brief overview of each type of insurance coverage:
- POS: POS insurance plans are a hybrid between HMO insurance and PPO insurance, allowing you the freedom to choose an in-network provider or go outside of the network.
- PPO: PPO insurance plans are the most flexible, allowing you to choose any healthcare provider in or out-of-network without a referral. This type of plan also typically offers low copays and coinsurance for in-network doctors.
- HMO: HMOs are low-cost insurance plans that require you to choose a PCP and get referrals for specialists. They typically have low monthly premiums, making them a popular choice for those with smaller budgets. However, the trade off is that you get less flexibility.
When it comes to what employers choose to offer, it could be a combination of these three–giving you the most options. Or, it could be only one or two.
Are there different types of POS health insurance plans?
Yes, there are many types of POS health insurance plans, and they vary by provider, terms, premiums, benefits, and plan name.
POS health insurance pros and cons
POS plans are often available at lower costs than other types of health insurance plans, but they have more limited providers. Luckily, they allow you to see out-of-network doctors, but it will cost you more.
There are pros and cons to each type of insurance plan. Understanding the benefits and drawbacks of POS insurance plans can help you determine whether it’s right for you and your dependents.
Pros of Point of Service Plans
- Affordable: POS plans are affordable, even though their premiums aren’t always the cheapest because they’re a hybrid of PPOs and HMOs. That being said, they’re less expensive than PPOs. The affordability comes into play when you receive a guaranteed in-network copy. POS plans offer copays for in-network providers on every visit instead of requiring you to pay the deductible before receiving coverage. This can be beneficial for those who don’t have large medical expenses.
- Out-of-pocket limits: With a POS insurance plan, out-of-network providers will require you to meet your deductible before you can get coverage. However, the annual cost is less than PPO deductibles, and there are limits on how much you pay throughout the year. Once the out-of-pocket limit is reached, your doctor’s visits and treatment will be fully covered by insurance.
- Flexibility: Even though in-network doctors might be limited, POS plans still have a good mix of available doctors, especially when compared to HMOs. Out-of-network fees are higher than in-network fees, but you’ll have access to a wide range of health insurance providers and specialists.
Cons of Point of Service Plans
- Cost: Even though POS plans are cheaper than PPO plans, they can still cost as much as HMO premiums. If you don’t fully understand your plan, you may be paying more money than another type of health insurance. For example, if your PCP is out of network, you’ll pay more to see them than you would with an HMO where they’re in-network.
- Confusing: POS insurance plans are less common than HMOs and PPOs, so they can be confusing to understand, making it difficult to determine how much you’ll pay when you visit a doctor or specialist.
- Paperwork: These insurance plans also require paperwork if you choose to see an out-of-network provider and pay their fees upfront, which may not be possible considering your budget. After you see the healthcare provider, you’ll need to file a claim for reimbursement and wait for the decision, which can be daunting.
The specific pros and cons of POS insurance for you and your family will depend on your needs. For example, if you consistently see an out-of-network provider, you may be faced with higher fees, negating some of the benefits of POS insurance. Therefore, even though your premium payment is lower than with a PPO, you’ll still be paying more for seeing a doctor.
A POS plan may be right for you if:
POS insurance plans are a great option for many individuals, especially if you're trying to save money and don't require healthcare services from an out-of-network provider. A POS plan might be right for you if:
- You're willing to coordinate your care through a primary care physician
- Your preferred doctor already participates in the network (use our Doctor Finder tool to find out)
- You understand how the process works, including the paperwork, referrals, and reimbursement claims
- You don't want to pay high premiums associated with PPOs
How can you find POS health insurance?
You can find POS insurance plans through your state marketplace or using a platform like eHealth. eHealth makes it easy to find the right health insurance plan for you based on your needs and budget.
With our tools, you can compare different plans, including POSs, HMOs, and PPOs, or shop for a POS plan by filtering your results by monthly premium. Using eHealth is free, and you can get help choosing your insurance plan from a licensed insurance agent standing by to answer your questions.
Get insured today
POS health insurance plans offer you a hybrid between HMOs and PPOs to help you get the coverage you need at the lowest possible price and give you access to affordable healthcare, whether from an in-network or out-of-network provider.
We get that a POS plan can help you save money on health insurance, but it might be confusing to understand–eHealth is here to help.
We connect individuals with quality, affordable health insurance plans by partnering with over 180 insurers and providing you with free access to a licensed insurance agent to help you understand your options. Interested in learning more about POS health insurance plans? Talk to one of our experienced agents or start using our tool to browse your options today.
What is a POS plan?
A Point of Service (POS) plan has some of the qualities of HMO and PPO plans with benefit levels varying depending on whether you receive your care in or out of the health insurance company's network of providers.
How does a POS plan work?
POS plans combine elements of both HMO and PPO plans. Like an HMO plan, you may be required to designate a primary care physician who will then make referrals to network specialists when needed. Depending upon the plan, services rendered by your PCP are typically not subject to a deductible and preventive care benefits are usually included. Like a PPO plan, you may receive care from non-network providers but with greater out-of-pocket costs. You may also be responsible for co-payments, coinsurance and an annual deductible.
A POS plan may be right for you if:
- You're willing to play by the rules and possibly coordinate your care through a primary care physician
- Your favorite doctor already participates in the network (use our Doctor Finder tool to find out)
*Definitions may vary by plan provider. Please read the provider's Summary of Benefits.
