POS Plans Offer Savings and Flexibility

One lesser-known type of health care plan, the point of service or POS plan, attempts to combine the freedom of a PPO with the lower cost of an HMO.

This page:

  Describes Point of Service health insurance

  Explains the advantages and disadvantages of POS plans

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How these plans work

The POS is based on the basic managed care foundation: lower medical costs in exchange for more limited choice. But POS health insurance does differ from other managed care plans.

When you enroll in a POS plan, you are required to choose a primary care physician to monitor your health care. This primary care physician must be chosen from within the health care network, and becomes your "point of service".

The primary POS physician may then make referrals outside the network, but then only some compensation will be offered by your health insurance company.

For medical visits within the health care network, paperwork is completed for you. If you choose to go outside the network, it is your responsibility to fill out the forms, send bills in for payment, and keep an accurate account of health care receipts.

Advantages and disadvantages of POS health insurance

Think these through first. With a POS plan:

  You have maximum freedom (for managed care).
  You are not limited to only HMO network providers.
  For network care, co-payments are low & there is no deductible.
  Annual out-of-pocket costs are limited.
  Co-payments for non-network care are high.
  There is a deductible for non-network care.
  Getting referrals for specialists may be difficult.

The cost

The breakdown of cost under a POS plan is similar to that of other managed care plans. It may be slightly less costly than a PPO because the health insurance company will still regulate most of your health care.

For example, to see a health care specialist you must first have a referral from your primary care physician. If the decision were up to you, you might choose an expensive non-network specialist, but your primary care physician (who works within the network) will probably choose a specialist from within that network. These controls reduces the overall cost of a POS health insurance plan.

Your actual costs will consist of the monthly premium and a copayment for health care services covered under the plan and within the POS network.

You'll also carry a deductible on any non-network care, and after the deductible is met, you'll still pay a higher percentage of the cost and maybe the difference between what the health care provider charges and what the plan deems to be "reasonable and customary" for the service.

Questions to ask about POS health insurance

If you are wondering, which is better a PPO, a HMO, or a POS health insurance plan, use the list of questions below as a guide. If, for any reason, the POS policy does not answer to your satisfaction, be hesitant about purchasing it.


   How many doctors are there to choose from?
   Are doctors in the network private or group practice physicians?
   Where are the offices and hospitals in the POS network located?
   How are referrals to specialists handled?
   What hospitals are available through the plan?
   What arrangements does the plan have for emergency care?
   What health care services are covered?
   What preventive services are covered?
   Are there limits on medical treatments or other services?
   How much is the health insurance premium?
   What, if any, are the copayments for specific services?
   How much more will it cost to use non-network physicians?
   What is the deductible and coinsurance for non-network care?
   Is there a out of pocket maximum?


We have prepared a printer-friendly version of these questions so that you may note the differences between various POS plans while you explore your options.

If you are ready to compare the many different plans available in your area, get an instant health insurance quote now.


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