Point of Service (POS) Health Insurance Plans: Health Coverage Guide

Updated: November 9, 2022
pos health insurance plans

Point of Service or POS health insurance plans commonly referred to as POS insurance is getting more popular than ever now that everyone needs a working insurance plan for health security.

Maintaining good healthcare has always been a priority for every citizen regardless of status or society. With the societal advancements we now possess, as well as the increased expenses of healthcare, it has been quite difficult for individuals to access quality healthcare especially when they’re not financially stable at the moment.

However, with the advent of healthcare insurance policies, it has been quite easier for individuals to access quality healthcare plans and free medical insurance for adults. And one of the most difficult tasks that individuals face in this regard, is choosing the most suitable health insurance plans for their needs.

Health Insurance Plans

There are quite a large number of available healthcare plans available, all of which have different features and modes of operation. Their out-of-pocket expenses, insurance coverage, services and network sizes all differ in a way that suits the policy providers.

Also, these health insurance provider companies all have different categories of health insurance plans like the Health Maintenance Organization (HMO) plans as well as the Preferred Provider Organization (PPO) plans all of which have their different modes of operation. However, there is a different plan called the Point of Service (POS) health insurance plan.

Just like the Health Maintenance Organisation and Preferred Provider Organisation plans, this plan has its requirements and mode of operation. And in this article, we would talk about the Point of Service health insurance plans and what you need to know.

 pos health insurance plans

What Is A POS Health Plan?

Normally, the Health Maintenance Organization and Preferred Provider Organization health insurance plans are quite complementary in the services they render, each with its peculiarities. The Point Of Service health insurance plan, on the other hand, combines the features of both the HMO and PPO plans under one plan. It is a managed healthcare plan that offers its services based on the kind of plan the policyholder requires as well as the kind of network of healthcare providers the individual will use.

Hence, one is to consider if the policyholder uses an in-network or out-network healthcare policy for coverage. Most policyholders have either a PPO or an HMO health insurance plan, and POS policyholders only make but a small percentage.

With Point of Service (POS) healthcare insurance plans, policyholders can have access to healthcare services at very cheaper prices but with a lower variety of plans to choose from even to get the best dental insurance or best vision insurance.

Although the various POS insurance plans might vary between insurance companies, these plans are generally a combination of both the Health Maintenance Organization plan and the Preferred Provider Organization plan giving the individual in question access to both in-network and out-network health services and facilities even though the level of coverage is mostly higher with in-network platforms.

Depending on the specific plan you’re on, most Point of Service policyholders are required to get referrals from their primary care provider, although this is not always the case even with the best supplemental health insurance. However, without these referrals, the individual either pays more for health services or doesn’t receive these services at all.

How Does A Point of Service Insurance Plan Work?

A Health Maintenance Organization and a Point Of Service health coverage plan are quite comparable. Normally, for the HMO plan, if the policyholder wants the coverage to pay for dental care for adults or other services of a specialist, they must select an in-network primary care physician and get referrals from that physician.

Most times,  the policyholder for HMO plans only offers insurance coverage for in-network services, hence when the policyholders use out-network services, they will pay more for the services that they would have if they used out-patient services.

However, a POS plan doesn’t have this disadvantage, because just as it is similar to the HMO plans in terms of in-network coverage, it also covers the out-patient services just like the Preferred Provider Organization health plan.

Now, if the policyholder leaves the network without a recommendation from their primary care physician, the POS plan will pay more towards the out-of-network service. We can say that the average cost of a POS plan is in between the greater cost of a PPO and the cheaper cost of an HMO. POS plans demand co-payments from the policyholder, but in-network co-payments are often just $10 to $25 per appointment.

A key advantage over PPOs is that POS plans do not have deductibles for in-network treatments. Patients who often travel will benefit from the nationwide coverage provided by POS policies. The fact that out-of-network deductibles for POS plans frequently have significant costs is a drawback.

Patients who use out-of-network treatments must pay the full cost of care up until their plan’s deductible when the deductible is high. Given the cheaper premiums of an HMO, a patient who never uses the out-of-network benefits of a POS plan would likely benefit more from switching.

When a policyholder visits in-network or out-of-network medical professionals, a point-of-service (POS) plan, which is a form of health insurance plan, offers distinct benefits. Compared to other types of plans, POS plans typically have lower pricing, but they could also have a considerably smaller pool of providers. With a POS plan, it is possible to see out-of-network doctors, but the prices could be higher, and the policyholder is in charge of filling out all the necessary paperwork for the appointment.

Although POS plans can be up to 50% less expensive than preferred provider organization (PPO) plans, HMO premiums can be up to 50% more expensive. The greatest aspects of HMO and PPO plans are combined in certain respects by POS plans, but you must choose whether this kind of plan is right for you.

Who Needs a POS Health Insurance Plans?

Generally, everyone needs quality healthcare, the type that is accessible from the POS health plan. However, if you desire the freedom to receive care outside of your network, POS health insurance can be a wise choice.

If you currently have a primary care physician who manages your treatment and doesn’t mind getting referred to specialists, it can also be a smart idea. Notwithstanding, before you get a POS health plan, it is good to take note of the pros and cons of this plan to be prepared as to what to expect when you get a POS policy.

Although POS plans are much less widespread than PPOs, HMOs, or EPOs, they can be a good fit for you if you don’t want to be restricted in terms of the doctors you can see. With this plan, you can see a wide range of doctors, including those that are outside your insurance coverage network.

pos plans


POS Health Insurance Plans Pros and Cons

Every healthcare insurance plan is not without faults though even if you should go for a healthcare plan with the fewest drawbacks or those with imperfections you can curtail. Although POS health insurance plans have numerous advantages, there are some drawbacks as well.

Before purchasing this kind of health insurance, it’s vital to weigh the advantages and disadvantages and you should only get the plan when you’re sure it suits your needs. So, what are the advantages of POS insurance? Let’s look into that and its disadvantages too.



One of the many health insurance options available to you and your family is point-of-service (POS) coverage. POS plans are a distinct category of health insurance that can be compared to a cross between HMO and PPO plans.

Point of Service health insurance programs has elements of each of these, which some people may find advantageous. The pros and drawbacks of a POS plan in comparison to other plans are listed below.

●      Access to out-of-network services:

With POS health insurance plans, you can visit a healthcare provider or specialist that is not within the plan’s network. Hence, you have a really wide range of health service providers to choose from. This is mostly utilized when you have a family doctor that accepts the POS plan.

●      Combination of both PPO and HMO qualities:

With POS plans, you can access services that are offered by both the HMO and PPO plans. And as we’ve mentioned, that’s because the Point of Service plan is majorly a combination of two other healthcare insurance plans.

●      Low out-of-pocket costs:

With POS coverage, individuals would not have to pay too much on deductibles and other out-of-pocket expenses. Some plans might offer low discounts such that the policyholder wouldn’t have to pay for deductibles.

Because co-pays are lower for POS plans than PPOs, if you have a medical bill, you will only be responsible for a very minute co-pay; the rest of the cost will be covered by your POS plan.

●      Absence of deductibles in some cases:

A POS plan’s absence of deductibles for local doctors is one of its obvious advantages. This means that until your insurance starts to reimburse you, you do not need to make any payments toward your medical expenditures on your own. In contrast, PPOs have deductibles


●      A primary care provider is needed:

One of the downsides of the POS plans is that it requires the coordination of a primary care provider. This is mostly a limitation for individuals with none because the plan would only be possible if a primary care provider is there to coordinate your plan.

●      The need for referrals:

To see a specialist, it is mostly required that you get a referral from your primary care provider and this is compulsory. So important that your insurance company might not cover your health expenses for visits without referrals.

●      The POS plans are not popular:

The POS plans are not as common as the HMO and PPO plans and depending on the area or policy provider, you might even be unable to access these plans.

●      Higher monthly premiums:

Due to the specificity and extra benefits of the POS plans, the monthly premiums are quite higher than the plans.

●      Deductibles must be met before benefits can be enjoyed:

The POS plan is such that, before coverage is provided for services, especially for an out-of-network provider, you must meet a deductible.

●      Higher co-pays for out-patient services:

When receiving out-patient services from an out-of-network provider, the expenses are mostly higher and depending on your plan you might have to pay about double its equivalent for an in-patient service.


Enrolling in a POS plan, which is a hybrid health insurance plan, can be a smart solution if you’re having problems choosing between an HMO health plan and a PPO plan. If you prefer to have a primary care physician who can oversee all of your medical care and want to occasionally be allowed to choose an out-of-network provider, having a POS plan may make sense.

Choosing a POS plan over an HMO may be advantageous if you reside in a small community with few healthcare providers or frequently require outpatient treatments. Additionally, a POS plan will probably be less expensive for your medical care than a PPO plan.

However, signing up for a POS plan may be worthless if you don’t intend to visit an out-of-network physician because you can save more money by signing up for an HMO plan. And you may want to enrol in a PPO plan instead if having a PCP seems more like a hassle than a benefit.

A POS plan might be the ideal option for someone who wants a PCP and options outside of their usual network of healthcare providers, excepting the drawbacks of having a POS plan, such as more administrative work and greater expenses for out-of-network care. You can select the plan with the finest coverage by weighing the benefits and drawbacks of POS plans and other kinds of employed or unemployed health insurance policies.

POS Health Insurance Plans FAQs

  • Which is the more preferable healthcare insurance plan, POS or PPO?

Flexibility is, in general, where PPO and POS plans diverge most. Preferred Provider Organizations, or PPOs, provide you with a lot of freedom to choose the doctors you want to visit, but at a price. Point of service, or POS, programs are less expensive but offer fewer options.

  • Is the POS plan a good insurance plan?

Yes, it surely is. Compared to other options like HMO, POS plans frequently provide a superior mix of in-network and out-of-network benefits. Members have more access to doctors and specialists even if out-of-network prices are typically greater than in-network fees.

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