What does pos stand for in health insurance

A Point of Service plan, or POS, is a health plan that uses certain doctors and hospitals, called your POS provider network. A POS plan has a lower premium than a PPO plan, but still provides options for choosing health care providers. These added choices may give you more flexibility when you need care.

POS plan features:

• You’ll choose a primary care physician (PCP) from the POS network to manage your health care needs.
• You’ll have a lower deductible and coinsurance if you see a provider in the POS network.
• You can see an out-of-network provider, but you will pay more of the bill.
• Emergency services are covered at the highest benefit level whether the provider is in the POS network or not.
• For the few covered services not available within the POS network, you may see an out-of-network provider at the in-network benefit level.
• You don’t need a referral to see a specialist. But make sure your PCP knows of the providers in this network.

Is a POS Right for You?

When shopping for a health plan for you and your family, ask these questions to see if a POS may be right for you:

• What type of health care do I expect for the coming year?
• Are the doctors and hospitals I use now, and may need in the future, in the POS network?
• If not, am I willing to see different providers so I have a lower monthly premium?
• Which POS plans are available, compared with the broader PPO networks?

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Home Knowledge CenterPPO vs. POS Plans: What’s the Difference?

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. There are many more details you'll want to compare, as well.

PPO vs. POS: What are the main differences?

When you're comparing health plans it's important to understand what sets them apart from one another. This way you can make a decision based on your needs. Here are some main features that you can compare to find out what makes a PPO different from a POS:

• Costs (deductibles, coinsurance, copays, and premiums)
• Primary Care Provider (PCP) requirement
• In-network requirement
• Referrals to other providers

Comparing costs between PPO and POS

When it comes to the costs for PPO vs. POS plans, how do they stack up?

• Deductibles: PPO plans usually come with a deductible. This means you pay for care and services until the deductible is met. Then your plan starts sharing costs. POS plans typically do not have a deductible as long as you choose a Primary Care Provider (PCP) within your plan's network and get referrals to other providers, if needed.
• Copays: Both PPO and POS plans may require copays. This is a fee you pay to a doctor at the time of a visit or for a prescription medication.
• Coinsurance: You may be required to share some of the costs for your care with both a PPO and POS plan. For a PPO plan, your coinsurance kicks in once you've met your deductible. With a POS plan, coinsurance costs could kick in if you need out-of-network care or fail to get referrals to see other providers.
• Premiums: This is what you pay monthly for your plan. Typically you will have a higher premium with a PPO because it offers more options. The POS plans usually have lower premiums because they offer fewer options.

Some health plans require you to choose a Primary Care Provider. A PCP can serve as a home base for care. They get to know you and your health needs and can coordinate care with other specialists when needed.

• PPO plans do not require you to choose a PCP, but it's recommended. Referrals to specialists are also not required.
• POS plans require you to choose a PCP and to get referrals if you need to see other providers, except for OB-GYNS. In fact, "point of service" means that your PCP is your number one go-to for care—they are your initial point of service. If you need to see specialists or get any other care, your PCP will coordinate it.

Do you have to see doctors in a network with a PPO vs. POS plan?

A network is made up of doctors and facilities that contract with an insurance provider. Network providers typically agree to offer discounted rates to customers, which is the advantage to staying in-network. Some plans require you to see providers in a network.

• PPO plans do not require you to see in-network doctors and you don't need referrals. If you choose to see providers outside the network you will pay more because coverage is lower. If saving money is important, simply choose to stay in-network.
• With a POS plan you would be required to see your in-network PCP. As your point of service doctor they would have to refer to any other provider if needed, in order for you to receive coverage under your plan. This includes both in- and out-of-network providers.

Should you choose a PPO or POS plan?

Which plan you choose depends on what best meets your needs.

• If you're looking for a lot of choice and flexibility, you might consider a PPO. No PCP required, no referrals, and coverage for both in- and out-of-network providers. This choice and flexibility comes with higher plan costs.
• POS plans cost less, but offer fewer choices than PPOs. If you're not concerned about having to stay in-network, choosing a PCP, or getting referrals for other providers, then a POS plan may work for you.

Before choosing any health plan, make sure to review the details of coverage. These are high-level descriptions of PPO vs. POS plans. Plans can vary widely between insurance carriers and those you may purchase on your own from the Health Insurance Marketplace .

How to Shop the Health Insurance Marketplace Copays, Deductibles, and Coinsurance What is Point of Service (POS) Health Insurance?

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Home Knowledge CenterWhat is Point of Service (POS) Insurance?

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.

• Your health care costs are typically lower when you get care from in-network providers.
• You can see a specialist outside of your approved network – and be covered, but you may pay more out-of-pocket.
• When you receive in-network treatment and services, the paperwork is usually done for you.

• Depending on the plan you choose, you may need to get a referral from your PCP to see in-network specialists.
• If you access care from outside your network, your health care costs may be higher.
• When you get out-of-network care and services, you may be responsible for all related paperwork, including managing the receipts and bill payments.

No. The above is a generic description of traditional POS health plans. Depending on the plan design and the insurance provider, the features of a POS plan may differ, as well as plan name.

POS insurance works best if you’re willing to follow the terms of this type of health plan. If you’re comfortable selecting a PCP to manage your care, this plan may be right for you.

Remember, even though a POS plan might have an overall lower cost, you may pay higher costs if you need to see a provider that’s outside your plan’s network. It’s worth checking to make sure the providers you normally see are in-network for the plan you’re choosing.

How to Shop the Health Insurance Marketplace Copays, Deductibles, and Coinsurance Buying Health Insurance: How to Choose the Right Plan Preferred Provider Organization (PPO) vs. Point of Service (POS) Plans

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