![]() It depends on what you want from your health plan in terms of network, premiums, flexibility, and coverage. Here are the pros and cons of a POS plan: POS plans generally have lower premiums than PPOs. The provider often serves as a gatekeeper before you can see a specialist. Unlike a PPO, you generally have a primary care provider who coordinates your care. Premiums for POS plans tend to be higher than HMOs and lower than PPOs. “As such, they are rarer these days, and we would not expect to see many, if any new POS plans offered in the future.” “POS plans were an evolution from HMO on the way to the PPO,” says Hope. ![]() However, you may need to get a referral from your primary care provider before you can see a specialist or go to the hospital. You just have to pay higher copayments to see them. You pay the lower copayments if you use providers that are in the plan’s network, but you also have coverage for out-of-network providers. You have higher cost-sharing if you go to out-of-network providers, but you still have coverage, similar to a PPO. With a POS plan, you can use both in-network and out-of-network providers. POS insurance has some of the flexibility of a PPO but also some of the restrictions of an HMO. These plans aren’t nearly as common as PPOs and HMOs.POS plan members need referrals from their primary care provider to see specialists.The health insurance plans require that you have a primary care physician who helps coordinate your care.POS health plans allow members to get care outside of their network of providers, but you have to pay more for out-of-network medical care.POS plans are more common in small firms than large firms - with 17% of the market share at small firms and 5% at large firms. The 2020 market share for all covered employees was 8% for POS plans, 12% for HMOs, 31% for high-deductible health plans, and 47% chose PPOs. ![]() In 2020, 31% of the employers surveyed by the Kaiser Family Foundation offered POS plans, compared to 11% for HMOs, 56% for PPOs and 26% for high-deductible health plans. The higher costs is one reason that members choose PPOs and HMOs more than POS plans. How do plan costs compare? The employee pays on average $1,419 for single POS coverage annually, which is compared to $1,212 for HMO single coverage and $1,335 for PPO single coverage, according to the Kaiser Family Foundation. “I would say that the POS was a bit of an evolution from the HMO world to the PPO world.” POS plans historically had a network that most closely resembled an HMO, meaning that the number of providers and hospitals might be a bit narrower than a PPO network,” says Hope. “The main difference between a PPO and a POS is the network. Like an HMO, you may need to get a referral from your primary care provider (PCP) for specialist and hospital visits. Like a PPO, you can see providers outside of the plan’s network, but you have higher copayments or other out-of-pocket costs. How does a point of service (POS) plan work?Ī POS plan is a managed care health insurance plan with a network of health care providers. Here’s what you need to know if your employer offers a POS plan as one of its options. “They were phased out in favor of PPO and high-deductible health plans.” “POS plans used to be more popular in the 1990s and early 2000s,” says Mark Hope, senior director, health & benefits consulting at Willis Towers Watson. POS plans were more common previously, but now only about 8% of covered employees are enrolled in POS plans, according to the Kaiser Family Foundation. ![]() A point of service plan health plan (POS) is a hybrid between preferred provider organization (PPO) and health maintenance organization (HMO) plans. ![]()
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