How Does a POS Health Plan Work?
With a POS health plan, you can receive medical treatment from physicians and institutions that have a contract with the health insurance company. These providers and hospitals are considered "in-network." The insurance company agrees to pay a set amount to these doctors for medical treatments and services.
A list of PCPs is given to you from which you may select one to handle all of your primary medical requirements, such as preventative care, yearly physicals, and sick visits. The PCP will recommend a specialist in the network if care from one is necessary. The cost of this service is entirely covered, with no deductible and a little copay.
You don't need a referral if you decide to seek treatment outside the network. The treatment you receive will be covered, but you will first need to pay a deductible out of your own pocket, and the plan will only cover a smaller portion of the costs. Your copay will also be greater if you receive care from an out-of-network physician.
What are the pros and cons of a POS?
POS insurance combines certain HMO and PPO advantages, but it also has some limiting conditions, such as expensive out-of-network care and specialized physician referrals. Here are some benefits of a POS.
Pros:
- The monthly rates are cheaper than with PPO plans. This is offset by your higher out-of-pocket expenses
- The ability to see a specialist outside of the approved network and still receive care.
- There is no deductible or a cheaper copay, and all paperwork is handled when you receive treatments from an in-network physician.
Cons:
- The advantage of paying cheaper monthly premiums is offset by greater out-of-pocket costs.
- When you are directed to an out-of-network health provider, the claims procedure, or requests for reimbursements, can be complicated and time-consuming when compared to other plans.
- The copays are greater when obtaining services from an out-of-network provider.
Deciding between an HMO, PPO, EPO, and POS can be confusing. Let one of our agents help you find the plan that best fits your needs. All plans are different and unique to your area and some may offer better benefits than you may think. Reach out to us and we will be more than happy to go over your options. Reach out to an agent.