Health Insurance- Point Of Service Plan

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A Point of Service (POS) health insurance plan provides access to health care services at a lower overall cost, but with fewer choices. POS plan is a type of managed care plan that is a hybrid of HMO and PPO plans. The term “point of service” refers to where and from what provider you receive services. Your coverage will vary depending on whether you see a provider who is in-network or out-of-network and if you have received a referral, if referral is required by your plan. 

Like an HMO plan, beneficiaries pick an in-network primary care physician to be their primary care provider. But like a PPO, patients may go outside of the provider network for health care services. When patients tak services out of the network, they will have to pay most of the cost, unless the primary care provider has made a referral to the out-of-network provider. In that case the medical plan will pick up the tab.

How POS Plan Works?

A POS plan is a comination of HMO and PPO plan. It requires the beneficiary to choose an in-network primary care physician and obtain referrals from that doctor if they want the policy to cover a specialist’s services, like the HMO plan requires as well. And a POS plan is like a PPO because it still provides coverage for out-of-network services, but the beneficiary will have to pay more than if they used in-network services. However, the POS plan will pay more toward an out-of-network service if the primary care physician makes a referral.

POS plans offer nationwide coverage, which benefits patients who travel frequently inside the U.S. Plan require the beneficiary to make co-payments, but in-network co-payments are often just $10 to $25 per appointment. POS plans also do not have deductibles for in-network services, which is a significant advantage over PPOs. On the other hand, out-of-network deductibles are very high.

Having two different deductibles in a POS plan may make a difference in your out-of-pocket costs. You will have one deductible for services you receive in your HMO network. You will have to meet a separate deductible for out-of-network services you receive as part of your POS option in the plan.You are also not allowed to combine the two deductibles and you have to reach each one separately. You may also have to pay a higher copayment or coinsurance for out-of-network services with a POS plan.

POS Plan Costs

Costs for a POS plan usually are somewhere between HMO plan and a PPO plan costs. But it is important to look at your particular situation to see if it is right for you. While POS plans may have a lower initial cost, they can become more expensive if you rely on out-of-network health care providers. You should check to see that the doctors, specialists and other providers you rely on are in the POS network of the plan you are considering.

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