October 24, 2023
2 minute read

Point of Service (POS) plans: How this type of insurance works

Should you get a Point of Service (POS) plan?

That’s a good question.

When you’re shopping for health insurance, you’ve got a lot of options, and this is one of them. If you’re wondering what a POS plan is all about, you’re not alone.

So, what’s a POS health plan? 

It’s formally called Point of Service health insurance.1

Wondering how this type of plan works?

Think of it as a hybrid of traditional health plans like HMO and PPO insurance. We’ll explain more about this in just a bit.

In this article, you’ll learn…

  • How POS health insurance works,
  • What coverage looks like, and
  • What to expect if you choose this type of plan.

Traditional health plans vs. POS health insurance 

Chances are pretty good you’ve heard of traditional-model health plans:

  • HMOs: Health Maintenance Organizations.2 They’re fixed networks of providers that only provide care within the network. If you get medical care outside the HMO network, you may pay full price, out of pocket.
  • PPOs: Preferred Provider Organizations.3 They’re more flexible networks of providers. You’ll pay less for care from an in-network provider. If you go outside the PPO network, you’ll pay more, but the plan usually covers part of the cost.

How is POS health insurance different from traditional plans?

POS health insurance plans include factors from both HMOs and PPOs.

They are a type of managed care that offers coverage for in-network and out-of-network services.

They’re similar to HMOs in that you receive more benefits by staying within the network, but you can still receive some coverage if you go out-of-network, like with PPOs.

POS health insurance: Pros4 

  • Pay less in-network. You’ll pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network.
  • No in-network referrals required. You can see an in-network provider without a referral. However, POS plans typically require you to get a referral from your primary care doctor in order to see an out-of-network specialist.
  • Flexibility to move between in-network providers and out-of-network providers without paying full price out-of-pocket for care

POS health insurance: Cons5 

  • Higher rates. POS health insurance plans typically have higher monthly premiums than HMOs. Essentially, you’re paying for a more flexible plan to get care from your choice of providers.
  • Primary care physician required. You’ll need to select a primary care doctor who is part of the POS plan. You may have fewer options than doctors participating in HMO and PPO plans.
  • More paperwork. POS plans give you more flexibility to see your choice of healthcare providers. However, you’ll also need to manage more of your own paperwork with a POS plan to request a referral, see a specialist, or submit a claim reimbursement.
  • Out-of-network deductible. POS plans allow you to see out-of-network providers. But you’ll typically have to meet an out-of-network deductible to access the benefits.

Looking for a POS health insurance plan?

We can help. Call (800) 827-9990 to talk with a licensed insurance agent about your health insurance options and to find out if a POS plan is right for you. Or find a licensed insurance agent in your area to learn more.

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© 2024 HealthMarkets Insurance Agency. All rights reserved.

* Medicare Advantage, Medicare Supplemental Insurance, and Part D options can be explored.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

HMIA003592

© 2024 HealthMarkets Insurance Agency. All rights reserved.

* Medicare Advantage, Medicare Supplemental Insurance, and Part D options can be explored.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

HMIA003592

© 2024 HealthMarkets Insurance Agency. All rights reserved.

* Medicare Advantage, Medicare Supplemental Insurance, and Part D options can be explored.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

HMIA003592