How Does a POS Plan Work?
As you shop for health insurance, you might come across the term POS plan in addition to the traditional HMO and PPO policies. The POS plan is a cross between both the HMO and PPO plan. They give you the flexibility of a PPO with the lower costs of an HMO.
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The Ins and Outs of the POS Plan
The POS plan is similar to an HMO because you have to pick a primary care physician. This is your ‘medical home.’ You must visit this doctor first before going to any specialists. If you need referrals, your primary doctor will provide them. The benefit of seeing your PCP first is usually the lack of deductible and copays required.
Where the POS plan differs from an HMO is in the choice of specialists you may see. With an HMO, you must see the doctor your PCP recommends and that is within your network. With a POS plan, you are free to see any specialist in or out of the network. It does benefit you to see a doctor in the network because you’ll pay a lower copay and may not have to meet a deductible.
You do have the option to see a specialist outside of your network though. If you do, you’ll be subjected to a higher deductible and copay. This could be beneficial for those that live in small towns or that have a favorite doctor that isn’t within the network of an HMO.
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The Benefits of the POS Plan
The POS plan has several benefits, especially when compared to the HMO plan:
- You’ll likely have lower copays and deductibles than a PPO plan if you stay in network.
- You have the flexibility to go out of the network if it’s something that’s important to you.
- You can see a doctor while traveling without paying for it 100% out of pocket.
The Downsides of the POS Plan
The POS plan, like any insurance plan, does have its downsides:
- If you do go outside of the network, you’ll pay hefty deductibles and copays.
- You may have to pay the full out-of-network doctor fee upfront and apply for reimbursement from the insurance company.
- You have to wait for a referral from your PCP to see a specialist, even if you are already established with one when you take the POS plan.
It’s important to weigh all of your options when shopping for health insurance. Ask yourself if you will use the out of network benefits. If you won’t, an HMO might suit you just fine. You’ll enjoy lower premiums and copays with the HMO plan. If you need that out of network benefit or you like the flexibility of seeing who you want, the POS plan could be a good choice. As always, compare the premiums and the benefits to see which you’ll use and which could be a waste of your money.
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