What is a POS Plan?

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by Health Insurance Expert
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Among the many types of health insurance plans in the industry, the one we will be talking about today is known as a Point-of-Service (POS) plan. A POS is a managed-care insurance plan that acts as a mix between an HMO and a PPO plan. This type of plan offers varying benefits dependent on the out-of-network or in-network services that are being sought. 

In a POS system, you’re required to choose a primary care physician that is a part of the health provider network. Not only is the PCP’s role to provide standard care and treatment, but it is also their job to issue a referral in order to obtain services from a specialist. 

When seeking treatment in a POS plan, the policyholder isn’t limited to in-network services exclusively. As of a matter of fact, they are encouraged to seek out-of-network treatment if possible since it is covered by the network. Although services from outside the network are covered, it is possible the policyholder will end up paying more in contrast to using in-network providers. 

Costs of a POS Plan

The costs of any insurance plan are contingent on several factors. First, depending on the plan you choose, the overall cost of your health insurance plan can fluctuate. Secondly, payment costs such as deductibles, copays, co-insurance, and premiums also add to how much you would be paying. 

The costs of a POS plan will be influenced by these measures. However, it is worth noting that when searching for one of these plans, the policyholder avoids several of the payment costs. Not only are they exempt from paying a plan deductible, so long as they choose a primary care provider, but they also generally pay lower premiums. 

In addition, as long as you’re utilizing in-network covered services, the out-of-pocket costs will tend to be minor. It is also worth noting that even if you utilize an out-of-network service, some of those costs will be covered by the insurance plan’s coinsurance, thus minimizing how much you pay out-of-pocket. 

How Referrals Work in This Network

How does the referral system work in a POS network? When the primary care physician you have chosen can’t treat a condition or ailment, they will refer you to see a specialist. In order to see this specialist, it is required for that referral to be obtained from the PCP. Otherwise, without the referral, any services the policyholder seeks for treatment will not be covered by the insurance plan.  

Is a Primary Care Provider Required in a POS?

The primary care physician is the point of contact in your health insurance plan that is tasked with dealing with the majority of your health-related ailments. In a POS plan, you are required to choose a PCP within the plan’s network. It is the role of your PCP to treat any underlying conditions you may have and provide referrals for specialists when needed. 

Although you are not constrained to using the POS plan’s PCP, you will be paying more for services that are outside of your insurance plan’s network coverage. Fortunately, even if you utilize an out-of-network provider, you are partly covered for those services only if done through the referral provided by your PCP.

How Does It Compare To Other Insurance Plans

In comparison to the Point-of-Service plans, there are other types of insurance plans with distinct features that are predominant within the marketplace. These features can alter the cost and services provided, and it is important to know the distinctions before choosing a POS plan. Some of these plans include:


An Exclusive Provider Organization (EPO) is a managed-care plan that allows policyholders to solely use providers and facilities within the EPO network. In this type of network plan, the individual is not allowed to use out-of-network services since the program itself doesn’t allocate resources to cover outside services. The sole reason as to why the insurance plan might offer out-of-network coverage is in the event of an emergency.

Correspondingly, when compared to a POS, you’re not mandated to choose a PCP, and generally won’t be required to have a referral to see a specialist. 


Health Maintenance Organization (HMO) plans are centered around providing a wide range of services through its vast, expansive network. For any individual looking to find a plan with broad preventive health services, an HMO might be a better deal for them. 

Similar to a POS plan, the policyholder is required to choose a PCP while also needing a referral to access specialist care. Additionally, plan costs will be minimal as HMOs tend to have lower premiums alongside requiring no deductibles. However, unlike the POS system, HMOs do not provide coverage for any services granted by out-of-network providers, unless you have a referral from your PCP. 


Preferred Provider Organization (PPO) networks are health insurance plans that contract medical professional services and their facilities for network policyholders. By only utilizing the providers in this network, you would be paying far less than by resorting to out-of-network services. 

With this in mind, policyholders in a PPO plan will pay higher premiums in order to offset the costs of administration and management within the system. Not to mention that individuals must also pay for co-payment fees for every visit alongside the deductible fees that must be paid in order for the insurance plan to cover the remaining cost of services. 

Why Should You Choose a POS Plan?

A POS plan might be your best choice if:

  • You desire high-quality coverage that offers the opportunity to choose any medical professional in the network.
  • You enjoy coverage flexibility with broad in-network and out-of-network benefits.
  • You prefer less costly insurance.
  • You do not mind having to choose a primary care provider nor having to get a referral for specialist care. 

Finding The POS Plan That’s Ideal For You

When browsing through the Health Insurance Marketplace, you must realize that POS plans will vary according to the region and state in which you live. In addition to the type of plan offered, service fees and premium costs are likely to vary. Check out our online form to get your personalized quote and compare plans.


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