A Point of Service (POS) health insurance plan provides access to health care services at a lower overall cost, but with fewer choices. Plans may vary, but in general, POS plans are considered a combination of Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. You can access care from in-network or out-of-network providers and facilities, but your level of coverage will be better when you stay in-network. If you have a point of service plan, depending on your specific plan design, you may be required to get referrals from your Primary Care Provider (PCP).
What does “point of service” mean?
The term "point of service" refers to where and from what provider you receive services. Your coverage varies depending on whether you see a provider who’s in- or out-of-network and if you’ve received a referral, if required by your plan.
How do point of service plans work?
Like an HMO, you start by selecting a Primary Care Provider (PCP) to help coordinate and manage your health care needs. Your costs for care will be lower if you see in-network providers. Like a PPO, you have choices about where to receive care. Your PCP may refer you to in-network specialists, if your particular plan requires it. You are also free to see out-of-network specialists, without a referral, but you could pay more for that flexibility.
FAQs
POS (point of service) is type of managed care plan where members appoint a primary care physician (PCP) from within the contracted network of health care providers. The PCP becomes their point of service because the PCP refers them to specialists and for further treatment.
What is a POS point of service plan in insurance? ›
A type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. POS plans also require you to get a referral from your primary care doctor in order to see a specialist.
What is a point of service POS plan is an example of? ›
A point of service (POS) health plan is a type of managed care health insurance that combines elements from both health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
Is POS insurance the same as PPO? ›
In general, the biggest difference between PPO vs. POS plans is flexibility. A PPO, or Preferred Provider Organization, offers a lot of flexibility to see the doctors you want, at a higher cost. POS, or Point of Service plans , have lower costs, but with fewer choices.
What are the disadvantages of POS insurance? ›
Disadvantages of POS Plans
Though POS plans can be up to 50% cheaper than PPO plans, premiums can cost as much as 50% more than for HMO premiums. While POS plans are cheaper than PPO plans, plan details can be challenging, the policies can be confusing, and many consumers don't understand how the associated costs work.
What is not a benefit of a POS plan? ›
A Point-of-Service plan, which combines elements of both Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans, provides certain advantages but does not ensure automatic acceptance for all applicants.
What does POS mean? ›
It stands for “point of sale,” which can be defined as the place where a transaction takes place between a customer and a merchant.
What is better, HMO or POS insurance? ›
POS: An affordable plan with out-of-network coverage
For slightly higher premiums than an HMO, this plan does cover out-of-network doctors. But you'll pay more. This is an important difference if you are managing a condition and one or more of your doctors are not in the network.
Can an individual who belongs to a POS plan use an out of network physician? ›
If you choose to go outside the POS network for treatment, you are free to see any doctor or specialist you choose without first consulting your primary care physician (PCP). Of course, you will pay substantially more out-of-pocket charges for non-network care.
What is POS type service? ›
A POS or point of sale is a device that is used to process transactions by retail customers. A cash register is a type of POS. The cash register has largely been replaced by electronic POS terminals that can be used to process credit cards and debit cards as well as cash.
Generally speaking, an HMO might make sense if lower costs are most important and if you don't mind using a PCP to manage your care. A PPO may be better if you already have a doctor or medical team that you want to keep but doesn't belong to your plan network.
What do PPOs and POS have in common? ›
Both PPO and POS plans have provider networks. In these networks, providers contract with the insurance company for payment. Both plans have many of the same types of costs, including premiums, copays and coinsurance.
How do I know if my insurance is HMO or PPO? ›
However, if you've already got a health plan and don't know which plan type you have, you can check your insurance card or contact your insurance provider directly. If you have an online account through your provider that allows you to access plan details, you can also start there.
How does POS insurance work? ›
A Point of Service (POS) health insurance plan provides access to health care services at a lower overall cost, but with fewer choices. Plans may vary, but in general, POS plans are considered a combination of Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans.
What are the drawbacks of POS? ›
Written and reviewed by:
| Advantages | Disadvantages |
|---|
| Better customer service | Costly prices |
| Easier team management | Reliance on your internet connection |
| Saved time | Malware infections |
| Multi-store systems | Security risks |
1 more rowMay 2, 2023
Network issues are a frequent POS system problem that can disrupt your business operations and communication. They can include issues such as poor connectivity, slow speed, or downtime. Network issues can cause loss of data, reduced functionality, or inability to process transactions.
What is the difference between an HMO and a POS plan? ›
HMOs will not cover out of network care. With a POS, or point-of-service plan, you also have one PCP who manages your access to other doctors. However, you can visit doctors out of network but it will cost more. With a PPO, or preferred provider organization plan, you don't need a referral to seek additional care.
What does POS stand for in Medicare plans? ›
The Point-of-Service (POS) option is offered in some Health Maintenance Organization (HMO) plans. Most HMOs only cover care from in-network providers, except in case of emergency. The POS option allows you to receive coverage for certain services out of network, but usually at a higher cost.
Which of the following is considered to be a point of service plan? ›
Expert-Verified Answer. The managed care plan is considered a point of service (POS).
What is an EPO plan vs POS? ›
EPO PlansEPO plans generally let you see any network provider you choose. There's no requirement to choose a primary care physician or get referrals to see a specialist. These plans do not offer out-of-network benefits. POS plans usually require you to get referrals to see specialists.
