Point of service health insurance plans have a combination of HMO and PPO properties, and is part of the managed care health insurance system. Like an HMO health plan, you select an in-network primary care physician to help orchestrate all of your care. Having access to a network of providers, hospitals, and facilities can be very beneficial and cost-effective. POS plans also usually have a restriction on co-payments and lower deductibles (or no deductible if you choose in-network).
With a POS plan, receiving care from an out-of-network provider is an option, though you will pay for the majority of the expenses out-of-pocket. If your primary doctor refers you to an out-of-network provider or facility, insurance will give more significant coverage. It is helpful to have the ability to personally select the source of your medical care, instead of having only in-network options.
Some areas of the country do not have very large networks, and it would be preferable for you to go to a facility that is not included in your network. Other times, there are highly recommended specialists that may not be covered by your insurance. These are only a few reasons out-of-network care can be a good alternative. Out-of-pocket costs are limited in most POS plans, though there is also a deductible charge for non-network care on top of the co-pay.
Though there are more options than an HMO, the limits are still strong and can get expensive. Due to the vast difference between in-network and out-of-network costs, it is recommended to use the network of providers and keep your health care affordable. Co-payments are very low for in-network services (between $10 – $40 for a regular office visit) and the in-network providers are still qualified professionals, so it can be a good option to simply pay a predictable flat fee.
How to Know if a POS Plan is Right for You
If you are an individual who feels a need to have options when it comes to health insurance, a POS may be for you. Here are some reasons why you may want to choose a POS:
- Having a designated primary care physician
- The ability to use out-of-network services or providers
- No (or low) deductibles and co-payments for in-network care
- Limited out-of-pocket expenses
- No need to consult with your PCP before receiving care out-of-network
Though there is freedom in this type of plan, getting out-of-network care can be more costly than you prefer. There is a much greater co-payment required when you go outside of your network, though you may feel it is worth the price. There is also a higher deductible with out-of-network care that you may not be able to or would rather not spend. You also may not want a primary care doctor, or the requirement to get a referral from them to see another in-network doctor or specialist.
1. Bills.com, “Point of Service (POS) Plan Information”. http://www.bills.com/pos-point-of-service-article/
2. USA-HealthInsurance.com, “A Point of Service Plan (POS)”. http://www.usa-healthinsurance.com/plans-point-of-service.html