Point of Service (POS) Health Insurance: What to Know & How to Save (2024)

Understanding the difference between various healthcare plans can be challenging. There are so many three-letter acronyms to keep track of, which can confuse you. One less-common acronym you may have encountered when looking at plan options is POS, or Point of Service. 

What is POS, and how is it different from other plans you’ll encounter when figuring out how to buy health insurance? Keep reading to learn more about Point of Service health plans and how they might save you money.

What is Point of Service (POS)?

According to the U.S. Office of Personnel Management, a plan offering Point of Service insurance products may incorporate features of a health maintenance organization (HMO) plan and a preferred provider organization (PPO), which is a type of fee-for-service insurance plan. 

In other words, it’s a hybrid plan. Point of Service (POS) plans allow you to pay less if you use hospitals, doctors, or other healthcare providers that belong to the plan’s specific network. 

As with a PPO, you have more choices for where to receive care. But, as with an HMO, you’ll need to be based with a PCP. So, if you want to take advantage of this type of plan, you will need to get a referral from your primary care physician (PCP) when you need to see a specialist.

What role does your primary care physician have in a POS plan?

Generally, you need to work with a primary care physician who will be responsible for any referrals when you need to see a specialist. You can receive care from an expert who is not your primary care provider or see an out-of-network specialist whenever necessary. However, you may not be able to access the same benefits as if you had stayed within the network.

If your existing primary care physician is already a member of the POS provider network, this type of solution may be attractive for you.

How much does Point of Service insurance cost?

If you enroll in point-of-service plans, you may pay less than a PPO policy, but it will be more expensive than HMO. However, you will have more flexibility than with an HMO and be able to see more care providers that are out-of-network. 

POS insurance plans include copayments and coinsurance as part of your annual out-of-pocket maximum. You may also need to consider an annual deductible with this policy type.

You may find that a health savings account is a great way to cover out-of-pocket medical expenses. However, you may not need to pay any healthcare deductibles when you receive care from your PCP, and preventative care should also receive full coverage.

Should you buy a POS insurance plan?

It’s a good idea to do your research before you buy so you can choose a POS plan to fit your budget and needs. Take time to compare different health insurance companies and see if their network of providers is attractive to you. 

Also, compare your out-of-pocket limits, coinsurance, and monthly health insurance quotes to strike a balance that works for your budget. Finally, check to see if you need to file a claim for reimbursement, as some plans may require this.

What To Know About Point of Service Plans

Point-of-service plans are managed-care health insurance plans that give you various benefits depending on whether you use in-network or out-of-network providers. It is a hybrid that combines features of an HMO and a PPO, the most common types of health insurance plans. 

You may pay more for high rates POS plans than you would with an HMO plan. Your out-of-pocket costs and expenses may also be higher, and you may not get the same benefits if you go to a doctor outside your network. 

Still, you will get more freedom to look for an out-of-network provider with a POS plan, and some people prefer this flexibility.