One of the things that we ought to see when we’re finding health insurance is its benefits. As a policyholder, of course, we want to have the plan to make us feel valued and considered.
We look for policies that show importance to our health and well-being. By providing benefit plans for our health sustenance, we feel appreciated.
Are you here to know things about these plans before getting them? Do you want to know the highs and lows of these plans and how they can actually help you?
Let us all see how this whole insurance benefit works that huge companies provide.
What is a POS Insurance Plan?
A point-of-service insurance plan (POS) is a type of plan that helps customers lower their medical expenses. It is a unique kind of managed healthcare insurance. It is a combination of features from both HMOs and PPOs.
The “point of service” term relates to what provider you receive services where and from. Your coverage upon having a POS plan varies depending on the medical treatment you may need.
You may use it in hospitals, clinic visitations, doctor check-ups, and other healthcare providers in your plan’s network.
This plan costs less than other policies, but its providers are usually limited. Its premium plan usually ranges between lower premiums in HMO and higher premiums in PPO.
How does POS work?
POS plans also have a network of specialists, hospitals, and other medical providers. With POS plans, you can visit providers that are under in-network.
It requires you to select a Primary Care Provider (PCP) to help you regulate and manage your healthcare demands. It is the care provider you can go to regarding all your health-related issues.
The cost for in-network care providers may be lower. However, it requires referrals from your PCP to allow you to see different specialists that are out-of-network.
If you want to go to an out-of-network provider without a referral, you may be paying more. The policyholder is responsible for all the documents when you go to an out-of-network provider.
This kind of plan may seem helpful for outpatient services. It is a designed flexible plan because policyholders can visit their providers anywhere.
POS or PPO: What is the difference?
When comparing health policies, it’s essential to know that each plan varies based on its target policyholders. With this in mind, you can choose your policy based on your medical needs.
However, there are more factors that you may need to consider in choosing the best health plan for you. Today, we’ll see where Preferred Provider Organization (PPO) and Point-of-Service (POS) plans differ.
Primary Care Provider Referrals and Requirements
The huge difference between PPO and POS plans is the flexibility that the two offer.
At a higher expense, you may see a lot of doctors that you want with PPO. However, you may have the POS plan at a low cost but with smaller choices of providers.
As stated, POS insurance requires you to select a PCP to be your gatekeeper in all your medical-related issues. You are also required to get referrals from your PCP before you see other care providers.
It may look like, with POS, your selected PCP is your initial go-to care provider, your “point of service.”
However, with PPO plans, choosing a PCP is recommended but not required. Also, if you have to go to other specialists, you may no longer need a referral.
Expenses and Charges
You may also want to consider things when it comes to expenses regarding PPO and POS plan.
The PPO plan comes with a deductible in which you’ll pay for the services provided until the deductible is reached. By then, your plan is going to start sharing costs.
On the other hand, the POS plan doesn’t have a deductible as long as you have your PCP within your plan’s network.
Both PPO and POS plans require copayments. This is the fee that you pay for a doctor’s visitation or medical prescription.
Copayment rates are different depending on medical procedures in a hospital or clinic that you visit.
With both PPO and POS plans, sharing some of the expenses for the services may be required.
In the PPO plan, your coinsurance comes once the deductible is met. In a POS plan, it may be effective if you need out-of-network providers with or without referrals.
This is your monthly payment for your health plan. You may have a higher premium with a PPO since it offers more care providers. The POS plans are lower because of fewer healthcare provider options.
You may consider a PPO if you’re more for choices and flexible providers. It covers both in- and out-of-network care providers and without PCP requirements and referrals. You can get this plan at a higher cost, though.
You may research other Guide to Medical Insurance: Deductible, Copays, and Coinsurance to be familiar with how it works.
In- and Out-of-Network Providers
Both plans offer limited coverage to policyholders who wish to go out-of-network for medical services. However, POS out-of-network coverage is smaller than that of in-network coverage.
Network providers typically agree to extend discounted rates to clients, which is the benefit of staying in-network. Some plans expect you to go to in-network providers.
In a PPO plan, you are not required to see in-network specialists, and you don’t need referrals, either. If you wish to see providers outside your network, you have to pay more because it has lower coverage. If you want to save money, you may want to stay in-network.
In a POS plan, you are required to go in your in-network PCP. Your point-of-service doctor would need to refer you to any other provider if necessary. For you to get your coverage under your plan, this involves both in- and out-of-network providers.
Upon contemplating, what plan do you think is the best to meets your needs?
If you want to pay fewer expenses, the POS is best for you. Staying in your home-based care or getting referrals eventually to see other providers is perfectly adequate.
But if you want to be more flexible and have other options, you may choose PPO. But being free may cost a higher expense.
Advantages and Disadvantages of POS Plans
Like any other policies, the POS plan has its own complementary features. Here are the possible ups and lows when you choose to have a POS plan to see if it suits you.
- You can choose your own provider to get yourself familiarize and comfortable with, but you can still go out-of-network if needed.
- It has lower premiums and copayments compare to other health policies when you go to in-network providers.
- You don’t need to be concerned about your yearly deductibles.
- A POS plan gives you more range and options than an HMO.
- To certain degrees, some of your medical needs from out-of-network providers are still covered.
- Your coverage is limited, and it will cost you higher if you go out-of-network.
- It usually has a higher coinsurance cost than a PPO.
- There is much paperwork required in a POS plan, especially if you need to reimburse out-of-network services.
- Going to out-of-network providers will require you a higher copayment.
- You still need approval from your PCP before seeing a specialist in your in-network if you want to be covered.
A POS plan doesn’t suit everyone perfectly. What works for you may not work for me or any other else. That’s why it’s essential to get to know the information of this plan deeply before actually getting it.
A Point-of-Service plan may look like an excellent choice for your health coverage. What could go wrong?
Remember, you may still pay higher if you need to go to a provider that’s not in your plan’s network. Ensure that the providers you regularly see are in-network for the plan you’re going to choose.
There are many things you may want to consider before getting a POS plan. Make sure it’s the right choice for you by acknowledging the following:
- Consider your specific medical necessities.
- Inquire for POS plans that can provide you primary healthcare service at an expense you can afford.
- Make sure to evaluate all the coverage of the plan.
The POS plans may differ in their features depending on their design plan and insurance provider. It is better to talk to professionals that offer this kind of plan to know what’s best for your needs.
If you find this article helpful for you, you may want to read these also:
- Guide To Medical Insurance Deductible, Copays, and Coinsurance
- 3 Tips to Find the Cheapest Health Insurance Rates
- Health Insurance Penalty: A Guide Of What It Involves And How To Avoid It
You may share this with your friends and loved ones to know the best health plan for them. Comment down below and share your thoughts upon reading this article.