A POS health insurance plan is a combination of elements from both HMO and PPO plans. It helps you receive care from either an in-network or out-of-network provider. However, if you wish to get medical care from an out-of-network provider, expect to pay more.
Your coverage under a POS plan depends on whether you receive care from an in- or out-of-network provider.
How do POS Health plans work?
Just like an HMO or PPO, you will be required to select a primary care provider who will assist in coordinating and managing all of your health care needs. If you choose an out-of-network provider, the cost of care will be on the high side. To save money, it is advisable to work with an in-network provider.
Regardless, you are free to choose whichever provider you wish to work with; a POS plan allows that. The most important thing is to choose a specialist who is adept in the field of medical care you need.
What is the cost of an average POS health insurance plan?
The cost of a POS health insurance plan depends on a variety of factors. On the Affordable Care Act (ACA) marketplace, the average amount an individual pays per month for a POS health insurance plan is between $505 and $794. The following factors can also affect the premiums charged on your POS health insurance plan:
- Age
- Location
- Type of plan
- Tobacco use
- Plan tier.
- Dependents
Furthermore, the cost of a POS health insurance plan depends on where you’re getting the coverage. The price varies across different insurance companies and you might be able to get a better and more competitive rate if you look around
Pros of POS Health Insurance Plan
There are several advantages of purchasing a POS health insurance plan, some of which include:
- Flexibility: Compared to other health plans, a POS health insurance plan gives individuals the option of going out of network. If you decide to visit a specialist that is not within the plan’s network, you are free to do that.
- Low out-of-pocket costs: Unlike other health plans, POS health insurance plan is not that expensive to maintain. This health plan has lower out-of-pocket cost and some plans may not even have deductibles. Also, if you use an in-network provider, the cost of your health care is going to be low.
- Offers sufficient coverage: Since POS health plan features a combination of elements of a PPO and HMO; policyholders get adequate coverage for their distinct health needs.
In addition to the aforementioned benefits; when you use an in-network provider, you don’t have to bother about the paperwork; everything will be done for you.
Cons of POS health insurance plan
Asides the benefit offered by POS health insurance plans, there are also some potential drawbacks, such as:
- Must work with a primary care provider: Most POP health insurance plan requires you to work with a primary care provider who will help manage your health needs.
- Referrals are required: In most cases, in order to see a specialist, you need a referral from your primary care provider. Should you see a specialist without a referral from your primary care provider, the expense may not be reimbursed by your insurance company.
- Higher cost: In a situation where you get out-of-network service and treatment, your health care cost will most likely be on the high side.
- Not as prevalent as other types of health plans: It is very rare to find POS health insurance plans in some insurance companies, even in ACA marketplace.
FAQs
Are POS plans more expensive than other plan types?
Because POS health insurance plans offer more flexibility than other plans, they can be more expensive. Most POS plans allow policyholders to see out-of-network providers based on their preferences. Nevertheless, they can also be less expensive than traditional PPO plans because they offer lower premiums.
In all, the cost of purchasing a POS health insurance plan depends on various factors, such as your health need, location, specific plan details and utilization.
Can I switch between in-network and out-of-network providers?
Of course, you can! POS plans are so flexible that they allow you to see both in-network and out-of-network providers. But have it in the back of your mind that you’ll pay more to see out-of-network providers.
That being said, it is essential to check your health plan documents to have a better understanding of the rules and requirements for using out-of-network providers.
How is a POS plan better than other plan types?
Although POS plans usually have higher out-of-pocket charges for those services, they give greater flexibility to see out-of-network providers than HMOs do.
POS plans often have lower rates than PPOs, but they may also have more limitations, such as requiring a referral from a primary care physician in order to see a specialist.
