What is a POS plan?

POS stands for Point of Service. A POS plan is a mix of an HMO and a PPO.

When you stay in network, it works like an HMO: you usually choose a primary care physician who handles routine care, and you need a referral to see an in-network specialist. Unlike an HMO, a POS plan also pays part of the cost when you see an out-of-network provider.

How out-of-network care works on a POS plan

• Out-of-network care usually has its own deductible and out-of-pocket maximum, and both are much higher than the in-network amounts.
• You may need to pay the provider up front and file the claim yourself.
• Out-of-network providers can bill you for the difference between their charge and what the plan allows (balance billing), except where the No Surprises Act protects you.
• You can usually see an out-of-network specialist without a referral, but you pay the higher out-of-network cost sharing.

When a POS plan makes sense

• You want HMO-style pricing but one of your doctors is outside the network.
• Someone in your household lives or studies away from home part of the year.
• You want some protection if you need a specialist the network does not have.

If all of your doctors and your hospital are in the network, an HMO usually gives you the same in-network benefits, sometimes at a lower premium. A POS plan is not always more expensive, though, so compare plans for your own ZIP code.

See how POS plans compare with HMOs, EPOs and PPOs: HMO, PPO, EPO or POS: Which Plan Type Is Right for You?

Plan rules vary by carrier and plan, and the Summary of Benefits and Coverage and policy for each plan govern. Questions? Call 855.847.7020 or email help@ihealthagents.com. Our help is free.