Understand Your Point-of-Service Plan’s Trade-Off
Save money with a limited network, but you’ll need a referral.
Written by: Andrew Hall
Point-of-Service (POS) benefits depend on whether the policyholder uses in-networkIn-network refers to the doctors, hospitals and other providers that are inside of your provider network. A provider network is a group of providers that have agreed with your health insurance company to treat its customers. or out-of-networkOut-of-network refers to doctors, hospitals and other providers that do not have an agreement to treat your health insurance company's clients. Visiting an out-of-network provider typically means more out-of-pocket costs and less coverage. health care providers.
POS plans only represent a small share of the health insurance market.
POS plans usually deliver lower costs, but they come with a limited provider networkA provider network is a group of doctors, hospitals and other specialists who agree with an insurance company to treat its clients. It's usually less expensive for you to see a doctor within your provider network..
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A POS plan is different because it provides services that are like both an HMO and PPO. A POS plan is similar to an HMO because you must have an in-network primary care doctor, and they must refer you to any specialty care. The same POS plan is similar to a PPO because you can be covered for services outside your network.
Here’s a comparison of the trade-off between POS v. HMO v. PPO:
Must select a primary care provider for specialty referrals
- HMOs and POS plans require you to have an in-network primary care provider (PCP). To receive specialty care, the PCP must refer you to a specialist.
- PPO plans do not require you to have a PCP and do not require referrals for specialty care.
Your responsibility costs for services from providers outside of your plan’s network
- An HMO plan will usually require you to cover most or all of the costs for an out-of-network provider.
- POS and PPO plans allow you to see providers out of your network. Your plan usually covers less of your costs for an out-of-network provider than in-network providers.
The cost of a POS plan may be a barrier. It’s cheaper than a PPO plan (the highest premium), but the premiums for a POS plan can be much higher than HMOs. With a POS plan, your out-of-network deductible is high. Unless you’re planning to use the POS plan’s out-of-network services regularly, you may want to consider the HMO because you could save money on lower premiums.
Are you eligible for cost-saving Medicare subsidies?
The term “point of service” refers to where and what provider you visit for services. Your coverage varies on whether you see a provider who’s in- or out-of-network and if you’ve received a referral.
No. Depending on the plan design and the insurance provider, the features of a POS plan may differ, as well as plan name. Regardless of plan or name, POS insurance works best if you’re willing to follow the terms of the health plan.