Introduction
When shopping for health insurance, you’ll come across dozens of different plans. One popular option is a point-of-service (POS) health plan. This type of health insurance provides a wide range of benefits and options for those looking for comprehensive coverage.
Overview of a POS Health Insurance Plan
A POS plan combines elements of HMOs and PPOs. It has the same cost-saving features of an HMO but also allows members to use out-of-network providers like a PPO. A POS health plan typically requires members to choose a primary care physician (PCP) who will serve as the gatekeeper for all their healthcare needs. The PCP is responsible for referring patients to specialists when necessary.
What Does a POS Plan Cover?
POS plans cover a variety of medical expenses including doctor visits, hospital stays, emergency services, lab tests, and prescription medications. Some plans may also provide coverage for vision and dental care. Depending on the plan, members may also have access to discounts on gym memberships, health clubs, and other wellness-related activities.
Understanding Your Out-of-Pocket Costs
POS plans have deductible and copayment requirements. Deductibles are the amount you must pay out of pocket before the insurance company begins paying for covered services. Copayments are the fixed amounts you must pay for each visit or service. These payments can vary depending on the type of service received and whether it was provided by an in-network or out-of-network provider.
Comparing a POS Plan vs. Other Types of Health Insurance
A POS plan is a good choice for those who want more flexibility than an HMO and more cost savings than a PPO. Here are some of the main advantages and disadvantages of a POS plan:
Advantages:
- Allows you to see out-of-network providers while still receiving some cost savings.
- Often covers preventive care with no out-of-pocket costs.
- Lower premiums than PPOs.
Disadvantages:
- Out-of-pocket costs may be higher than with an HMO.
- Requires referrals from your primary care physician for specialty care.
- May not cover as many services as a PPO.
Cost Considerations
The cost of a POS plan varies based on factors such as your age, location, and the level of coverage you choose. According to a study published in Health Affairs, in 2017 the average annual premium for single coverage was $6,719 for a POS plan, compared to $6,845 for a PPO and $5,918 for an HMO.1 Keep in mind that the premiums don’t reflect the full cost of the plan — you should also factor in the out-of-pocket costs you may incur.
How to Choose a POS Plan That’s Right for You
Choosing the right POS plan depends on your individual needs and budget. Here are a few tips to help you make an informed decision:
Evaluating Your Coverage Needs
Make sure the plan you choose covers any medications, treatments, or procedures you may need. If you have a chronic condition or require regular checkups, look for a plan that covers these services without a large copayment. Also, consider how often you visit the doctor and if you need to see specialists.
Researching Different Providers
It’s important to compare the benefits and costs of different POS plans to find one that fits your budget and meets your needs. Check to see if the plan covers your preferred doctors and if it has a network of in-network providers. You should also compare the out-of-pocket costs for each plan, such as deductibles and copayments.
Tips for Making the Most of Your POS Plan
Once you’ve chosen a POS plan, there are several steps you can take to maximize your coverage and save money:
Utilizing In-Network Providers
POS plans offer lower copayments and coinsurance rates for services performed by in-network providers. Make sure to ask your doctor or specialist if they are in your plan’s network before scheduling an appointment.
Maximizing Preventative Care
Many POS plans cover preventive care with no out-of-pocket costs. Take advantage of these benefits and schedule regular checkups and screenings. Doing so can help you identify potential health issues early and avoid costly treatments down the line.
Taking Advantage of Discount Programs
Some POS plans offer discounts on gym memberships, health clubs, and other wellness-related activities. Ask your insurance provider if they offer these types of discounts and take advantage of them whenever possible.
Conclusion
A POS health plan is a great option for those who want a balance between cost savings and flexibility. When choosing a plan, make sure to evaluate your coverage needs, research different providers, and take advantage of in-network providers and discount programs. With the right plan, you can get the coverage you need without breaking the bank.
1Sommers, Benjamin D., et al. “U.S. Employer-Sponsored Health Insurance Premiums Rose Modestly in 2017.” Health Affairs, vol. 37, no. 4, Apr. 2018, pp. 665–672., doi:10.1377/hlthaff.2017.1578.
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