When it comes to finding health insurance plans, it’s important to find options that afford you the coverage and cost that works for you. What about a plan that combines HMO and PPO characteristics into one?
A Point of Service (POS) plan does just that – it shares commonalities between both HMO plans and PPO plans to offer a more customizable insurance option.
Like an HMO insurance plan, a POS plan requires you to choose a primary care provider (PCP) to handle all your standard medical care. However, like a PPO plan, you may have some of the costs of out-of-network providers covered for you.
However, with POS health insurance plans, your out-of-pocket costs for seeking treatment from an out-of-network provider or a specialist depend on whether you receive a referral for services. A referral is a recommendation from your primary care provider; with it, the doctor agrees that the services you require are not within his or her scope of practice, therefore allowing you to seek treatment elsewhere.
You may still be responsible for paying certain costs associated with receiving care from an out-of-network provider. Still, the costs will be substantially lower when you receive a referral from your primary doctor beforehand. Also, keep in mind that POS health insurance plans require you to complete your own paperwork whenever you seek treatment from an out-of-network provider.
POS plan premiums range between HMO and PPO premiums – they are not quite as expensive as PPO plans but cost nearly twice as much as PPO plans.
One of the biggest benefits of POS health insurance plans is that there usually aren’t any deductibles when you seek services from in-network providers. So, if you are looking for a low-cost plan and stay within your network, you could save a lot in out-of-pocket costs compared to paying a high deductible for an HMO plan.
There are, however, deductibles for out-of-network providers with most POS plans. If you do need to seek care from a doctor or specialist who is not in the plan’s network, you could be looking at a high deductible, which could lead to large out-of-pocket expenses for you and your family.
But what about health insurance plans for those who do not require extensive medical care and only want basic coverage? Low-cost health care plans like Exclusive Provider Organization (EPO) plans may be the best option. Learn more about EPOs, including who may be the best candidate for these plans, in the next slide.