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Affordable POS Health Plans
Point of service (POS) plans are a hybrid between HMO and PPO plans. Like both managed care plans, they include a network of specialists and a monthly premium. They allow patients the benefits of the HMO network and controlled costs, and the flexibility to go out-of-network, and self-refer to specialists, as in a PPO plan.
Sometimes, POS plans are called an “open-ended HMO” or “open-ended PPO” because of their hybrid offerings.
How POS Plans Work
Inside the network, as in an HMO, patients have no deductible and minimal co-pays for covered services. The primary care physician functions as the patient’s “point of service” and needs to provide a referral for the patient to see specialists within the network. Most of the paperwork for patients is done by the doctor offices and by the plan administrators.
Outside the network, the plan acts more like a PPO. There may be a deductible amount that needs to be paid out-of-pocket before the plan covers any of the fees. There is also a higher co-pay to see doctors or specialists outside the network, and no referrals are needed to see a certain specialist.
In some special cases, a doctor inside the network may also refer a patient to an out-of-network specialist. Some plans will cover most or all costs in those instances, because it is usually done when there is no network specialist that can provide the same type or level of service.
POS Plans Mix Freedom and Cost-Control
As you can see, Point of Service plans help patients mix the types of care they can get and increase their freedom, while still trying to control their costs. The deductibles for out-of-network care range depending on the plan’s administrators and the area of coverage. On average they might range from $300 to $600.
Point of Service plans also put a limit on the out-of-pocket costs that a patient can incur. On average, individuals might reach their cap around $2,400 while families may cap around $4,000. Once the insured person has paid the maximum out-of-pocket amount, the insurance plan will pick up the rest of the costs.
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