A point-of-service (POS) health insurance plan is an excellent option for those on a tight budget who want medical treatment. This type of health insurance plan is often formed from a combination of PPO and HMO plans.
While both in-network and out-of-network providers and organizations can provide healthcare, keeping in-network gives you better coverage. Furthermore, if your main plan is point-of-service, you may be mandated to receive referrals from your primary care physician (PCP).
What Is a POS Health Insurance Plan
A point-of-service (POS) health insurance plan is a managed care plan that provides different benefits based on whether the policyholder visits healthcare providers that are in-network or not. Moreover, this coverage combines elements of the two most popular health insurance schemes. Preferred provider organization (PPO) and Health Maintenance Organization (HMO) plans are examples of this. Most policyholders have PPO or HMO policies, making POS health insurance plans a minor portion of the health insurance industry.
How Does POS Health Insurance Plan Work
An HMO and a POS plan are similar. To gain insurance coverage for specialist services, an insured must select a primary care physician within their network and follow their recommendations. A POS plan, like a PPO, provides out-of-network treatment at a greater cost to the policyholder than in-network providers.
The POS plan pays more towards an out-of-network service referred by a primary care physician compared to a policyholder visiting the provider independently. A POS plan’s premiums are in the middle of an HMO’s and a PPO’s lower and higher premium ranges.
POS plans need co-payments, but, in-network co-payments range between $10 and $25 per appointment. Another significant advantage of POS plans over PPOs is the elimination of deductibles for in-network procedures. Patients who travel a lot may benefit from POS plans’ nationwide coverage.
The fact that POS plans typically have large out-of-network deductibles is a drawback. Patients using out-of-network treatments are responsible for the entire cost of care until they meet the plan’s high deductible. Because an HMO has cheaper premiums, a patient who never uses the out-of-network treatments provided by a POS plan would likely be better off with one.
Differences between POS Health Insurance Networks and Other Networks
The pricing, locations for care, and whether a PCP is necessary for routine care and specialist referrals are the primary differences between POS policies and other kinds of health insurance plans.
These additional kinds of network plans consist of:
Preferred provider organization (PPO)
A kind of health insurance plan where using in-network doctors results in lower costs. You can see specialists without a referral, you don’t have to declare a PCP, and you can receive care outside of the network for a higher fee. These explanations provide more versatility than the others, but they are typically more expensive.
Health maintenance organization (HMO)
Except for emergencies, this insurance coverage only covers benefits offered by the network’s doctors and other healthcare professionals. Specific HMOs need members to live or work within their service region to be suitable for benefits. To receive regular care, beneficiaries must designate a PCP, and the PCP must authorize referrals to specialists.
Exclusive provider organization (EPO)
Like HMOs, EPOs only cover in-network medical treatment unless an emergency arises. In contrast to HMOs, you can see in-network specialists without a referral or prior authorization, and you are not required to choose a PCP to oversee your care.
How Much Does a POS Health Insurance Plan Cost
Generally, a point-of-service (POS) plan under the Affordable Care Act (ACA) costs $505 per month for people under 30, $568 for individuals over 40, and $794 for those over 50. Additionally, some factors affect the amount a Point of Service (POS) health insurance plan costs in the ACA marketplace. The following factors may affect your health insurance premium:
- Age.
- Region.
- tobacco use.
- Plan level (Platinum, Silver, Gold, or Bronze).
- Reliances.
- Make a plan.
Your plan’s rates are affected by where you obtain coverage. Individual health insurance plans bought through the ACA marketplace are not the same price as those purchased directly from insurance providers. Purchasing a POS plan through your employer may result in a minimal rate because premiums for company-sponsored policies are lower.
If you fulfill the eligibility requirements, buying a financed plan through the ACA marketplace offers another alternative. The Affordable Care Act (ACA) provides premium tax credits and subsidies to low-income families to help them get health insurance.
Advantages and Disadvantages of POS Health Insurance Plan
Though POS health insurance plans provide different benefits, they also have certain disadvantages. Moreover, it is essential to analyze the advantages and disadvantages before getting this type of health insurance.
Advantages of POS plans:
- When compared to PPOs, their premium expenses are more affordable.
- Members can see physicians who are not in the network, but it will be expensive.
- Depending on the plan, they usually have a broader selection of in-network providers than HMO plans.
Disadvantages of POS plans:
- Monthly premiums are at least as high as those of HMOs and EPOs.
- When seeing an out-of-network provider, you may be expected to pay their fees upfront and then provide proof to your insurance provider for a refund.
- Referrals are required for them to consult specialists.
The requirements of your family or business will identify if a point-of-service (POS) resolution is proper for you. If you’re willing to select a PCP and your first choice physician is already covered by your coverage, they could be a suitable fit.
Who Should Get a POS Health Insurance Plan
POS health insurance may be a suitable option for people who prefer to receive healthcare outside of their network. If you already have a primary care physician observing your treatment and don’t mind being sent to specialists, this could be a smart decision. Furthermore, POS plans, while not as popular as PPOs, HMOs, or EPOs, enable the freedom to select from a variety of providers.