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Why Buy Health Insurance? |
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Medicare Info Center |
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A point of service plan, or POS plan,
is a type of managed care health insurance system. It combines characteristics of both the HMO and the PPO. Members of a POS plan do not make a choice about which system to use until the point at which the service is being used.
Point of service plans (POS) are sometimes called an ‘open ended HMO’ or an ‘open ended PPO’. This is because a point of service plan offers an approved network of medical care facilities and physicians for their policy holder’s to choose from just like HMOs and PPOs.
A major difference is that point of service plans allow for their policy holder’s to receive their medical care outside of the network, though use of facilities and physicians within the network is encouraged.
Based upon the idea that medical costs may be offered at a lower cost in exchange for limited choices in medical care facilities and physicians, point of service plans have several variances from similar plan types. For example, newly enrolled policy holders of a point of service plan are required to choose a primary care doctor to keep tabs on their health. This doctor becomes the new policy holder’s point of service and is chosen from the list of pre-approved doctors in the provider’s approved medical care network.
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Advantages of POS plans
Maximum freedom
POS coverage allows you to maximize your freedom of choice. Like a PPO, you can mix the types of care you receive. For example, your child could continue to see his pediatrician who is not in the network, while you receive the rest of your healthcare from network providers. This freedom of choice encourages you to use network providers but does not require it, as with HMO coverage.
Minimal co-payment
As with HMO coverage, you pay only a nominal amount for network care. Usually, your co-payment is around $10 per treatment or office visit. Unlike HMO coverage, however, you always retain the right to seek care outside the network at a lower level of coverage.
No deductible
When you choose to use network providers, there is generally no deductible. Thus, coverage begins from the first dollar you spend as long as you stay within the POS network of physicians.
No "gatekeeper" for non-network care
If you choose to go outside the POS network for treatment, you are free to see any doctor or specialist you choose without first consulting your primary care physician (PCP). Of course, you will pay substantially more out-of-pocket charges for non-network care.
Out-of-pocket costs limited
Healthcare costs paid out of your own pocket (i.e., deductibles and co-payments) are typically limited. The average yearly limit for individuals is around $2,400. For families, the average yearly limit is approximately $4,000.
Disadvantages of POS plans
Substantial co-payment for non-network care
As in a PPO, there is generally strong financial incentive to use POS network physicians. For example, your co-payment may be only $10 for care obtained from network physicians, but you could be responsible for up to 40% of the cost of treatment provided by non-network doctors. Thus, if your longtime family doctor is outside of the POS network, you may choose to continue seeing her, but it will cost you more.
Deductible for non-network care
In most cases, you must reach a specified deductible before coverage begins on out-of-network care. On average, individual deductibles are around $300 per year, and the average annual family deductible is about $600. This deductible amount is in addition to the co-payment for out-of-network care.
Tight controls to get specialized care
As in an HMO, you must choose a primary care physician (PCP). Your PCP provides your general medical care and must be consulted before you seek care from another doctor or specialist within the network. This screening process helps to reduce costs both for the POS and for POS members, but it can also lead to complications if your PCP doesn't provide the referral you need.
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