Point of Service (POS)
What Is a Point-of-Service Plan?
Point of service, or POS, is a managed healthcare plan. It combines elements of Health Maintenance Organization and Preferred Provider Organization plans. With a point-of-service healthcare insurance plan, you typically pay less if you use providers who are in the service plan network.
How Point-of-Service Plans Works
With a point-of-service, or POS plan, you receive care through your primary care provider, or PCP. If you need extra care, your primary care provider will refer you to other specialists within the network. You can go outside the network if you need additional care or you would like to visit a provider who is not part of the network. You will be asked to pay more unless your primary care doctor refers you outside of the network.
Pros and Cons of a POS Plan
POS plans make up about 10% of healthcare plans in the U.S. Here are a couple reasons people choose to enroll in a POS plan, and why some choose other options:
Pros
Some of the benefits of a POS plan include the following:
Primary Care Physician
In a POS plan, you will have a primary care physician. Having a primary care physician comes with many benefits including having a knowledgeable health provider who has an extensive understanding of your medical history.
Lower Premiums
With a POS plan, you tend to pay lower premiums. This is offset by your higher out-of-pocket expenses.
Out-of-Network Services
Your primary care physician has the ability to refer you to an out-of-network specialist, and your plan may still reimburse your for some of the costs. With other plans, seeing an out-of-network provider may require you to pay completely out-of-pocket.
Cons
Some of the drawbacks of a POS plan include the following:
Higher Out-of-Pocket Costs
With a POS plan you will get the benefit of paying lower monthly premiums, but the downside is it will result in higher out-of-pocket costs.
Longer Waits
Since you have a primary care physician, it may result in you seeing longer wait times when it comes to getting referred to a specialist.
Drawn Out Process
When you get referred to an out-of-network health provider, the claims process, or requests for reimbursements may be a complex and drawn out process, which can be a pain compared other plans.
How POS Plans Compare to PPO and HMO Plans
PPO and HMO plans have been around longer than POS plans. Each has advantages and disadvantages affecting different healthcare needs.
POS vs. PPO
PPOs, or preferred provider organizations, often have higher premiums and higher deductible amounts than POS plans. If you have a PPO healthcare plan, you can choose any physician you want. You could still receive lower coverage if you seek care outside of the PPO network of providers.
POS vs. HMO
Health Maintenance Organizations, or HMOs, operate in a managed care environment. If you are a member of an HMO, you will choose your primary care physician who will refer you to care within the HMO system. If you go outside the HMO system, you are usually responsible for 100% of those costs. A POS will provide some reimbursement for care outside the network.
Curious if a POS plan is right for you? Give one of our experienced agents a call 858-771-4087 or enter your zip code here!