As with HMO plans, POS health insurance plans require participants to select a Primary Care Provider (PCP), and may even require referrals for specialists. Unlike HMO plans however, POS plans enable participants to seek out-of-network care at higher costs;
POS plans represent a hybrid between HMOs and Preferred Provider Organization (PPO) plans.
In-Network and Out-of-Network Providers
Many people struggle to comprehend health insurance terminology, particularly regarding its various plans available. Although all plans provide similar coverage, there are notable variations between plans in how they operate – for instance, in-network providers offer discounted services than those outside their network owing to having signed contracts with insurance companies to receive payment at certain negotiated rates for their services.
Out-of-network providers don’t have an agreement with insurance companies and must therefore bill at full price for services rendered. Furthermore, out-of-network providers are free to balance bill you for amounts exceeding what insurers consider reasonable and customary amounts; so it is wise to try staying within your network whenever possible.
In-network providers are more likely to be covered by your plan than out-of-network ones; when visiting out-of-network providers, however, your insurance company usually only pays part of the bill once your deductible has been met – however this varies by provider so it is wise to reach out directly and see exactly how much will be covered for any given service.
POS (point of service) health plans offer managed care health insurance that combines aspects from both HMOs and PPOs. Participants select their primary care physician from a network within POS that will oversee all healthcare needs as well as referrals for specialist visits; similar to PPO plans, participants have the choice to go outside this network for treatment; this may increase out-of-pocket expenses significantly, however.
Always keep in mind that not all health care charges are equal, so take the time to research any new doctor or procedure you may be contemplating. Before scheduling an appointment with an out-of-network provider, speak to your PCP about whether the referral has been processed so as to prevent being charged for something which won’t be covered by insurance plans.
Copayments and Deductibles
Point of Service (POS) plans offer you healthcare options and costs that depend on where and how you get care. As with HMO plans, these POS plans typically contract with networks of doctors, specialists and medical facilities offering discounted rates – you’ll pay less when visiting providers in their network; perhaps even meeting your deductible is unnecessary!
When you need to see a specialist, your primary care physician (PCP) will typically refer you to one within their network. But for added flexibility and greater costs savings, your PCP may authorize seeing an out-of-network specialist; you will bear any associated increases and may need to meet your deductible before doing so.
Most point of service (POS) plans offer coinsurance coverage that divides responsibility for healthcare bills between insurer and patient into percentages. Once your deductible has been met, insurance usually pays between 10-20% of incurred bills; so for example if a procedure costs $500 but your health insurer only covers $200 of it.
As is common with PPOs and HMOs, POS plans typically feature an annual out-of-pocket maximum that limits how much out-of-network care you must pay annually; however, out-of-pocket maximums won’t apply once your deductible has been satisfied.
Consider your priorities when selecting a PPO plan as it offers greater freedom in choosing healthcare providers. But if you can sacrifice some flexibility and incur higher out-of-pocket expenses, a point of sale (POS) plan could make sense for you. No matter which healthcare plan you select, it’s crucial that you heed your doctor’s orders and use your coverage wisely in order to keep costs down and receive necessary care. Doing this will not only contribute to living a healthier life but will make affording other necessities much simpler.
Referrals and Reimbursement
Before purchasing health insurance plans, it’s essential to understand their differences and nuances. While PPO and POS plans may seem similar at first glance, their costs vary widely and could have an enormous impact on the coverage costs for you and your budget. Which plan will work best for you will ultimately depend on both variables.
Preferred Provider Organization, or PPO plans, are managed care plans with contracts with an in-network of doctors and medical facilities who agree to offer discounted rates to PPO plan customers – making staying within this network cheaper for plan customers. Unlike traditional health insurance policies, which often require visits with your primary care provider (PCP) first before seeing a specialist, PPO plans generally have lower costs overall.
Point-of-Service health insurance plans, or POSs, combine features from both HMOs and PPOs into one managed care plan. They allow members the freedom to see specialists without getting an initial referral from their PCP, but out-of-network fees will typically be higher than with an in-network visit.
PPO and POS plans both feature deductibles that must be met before your health insurance plan begins sharing costs, with most plans offering lists of preferred providers with lower out-of-pocket expenses; some PPOs also feature tiered arrangements where more expensive providers have higher associated costs.
Both PPOs and POS plans feature coinsurance costs in addition to their deductible payments, with coinsurance amounts that vary based on your plan type ranging from very minimal amounts up to considerable sums that may surprise you.
If a low annual deductible is your priority, PPO and POS plans could be an excellent fit. On the other hand, HMO or POS plans offer greater freedom when it comes to going out-of-network for visits or referrals; which might make an HMO or POS plan even better for you.
Choosing the Right Plan
When selecting an employee benefits plan for your company, it is crucial to carefully consider all relevant aspects. Costs, flexibility and a wide array of providers and services should all be kept in mind. Experienced insurance brokers are there to assist in finding a plan tailored specifically to the needs of your organization.
Point of Service (POS) plans have become one of the most popular types of health plans. These plans combine elements from both HMOs and PPOs; members must still select a primary care doctor from within their network before visiting specialists; however, unlike HMOs they allow members to seek out-of-network care at an increased cost.
Employers that want to provide their employees with more flexibility while encouraging them to utilize in-network providers will likely prefer the POS option as its deductible is typically lower than PPO plans and copayments are usually low for services offered within its network – an ideal choice for employees who may travel frequently or find it challenging to select doctors within its reach.
Selecting the ideal plan depends on the needs and preferences of your employees. If they seek lower costs, an HMO might be preferable, while for maximum flexibility PPO might provide them with more options and flexibility.
POS plans can be an excellent solution for small to midsized businesses that want to offer their employees some flexibility and value. As the marketplace for benefits continues to develop, it is vital that you understand all your available options to you so you can provide optimal protection and care for the most precious resource of all – your people.
