Understand Your Point-of-Service Plan’s Trade-Off

A POS plan is a managed care plan that combines elements of Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). POS plans offer both In- and Out-of-Network benefits and require a primary care provider to direct all specialized care through referrals.

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.