What is a POS Plan? Health Insurance Explained

by Zencare team

You may have heard that POS insurance plans have a combination of PPO and HMO insurance plan characteristics - but what exactly is a POS plan? And how will you know if it’s a good fit for you? We’ve collected all the information you need to know about POS insurance plans to make it easy to decide.

What is a POS?

"POS" stands for Point of Service. This insurance plan assigns you a primary care physician (PCP) to manage your care and offer you referrals to see specialists.

A POS insurance plan will have a list of in-network providers - visiting these providers is the cheapest option because you have the most coverage. There are two ways to see an out-of-network provider, the first of which is more cost-effective.

  • Ask for a referral from your PCP. Your PCP will provide you with a referral to see an out-of-network provider and receive partial coverage for the visit.
  • Visit the out-of network provider without a referral. In this case, you will pay for more of the appointment cost. If you skip the referral step, you might still have some coverage from your POS plan, however you will certainly pay more out-of-pocket than if you get a referral first.

How do I know if I have a POS plan?

In order to figure out the type of insurance plan you have, check out your insurance card - generally, the type of insurance plan is listed by the name of the plan.

If you don’t see it there, refer to your Summary and Benefits  - the information about the plan type should be near the top, detailing whether your plan is a POS or another type of insurance. If you still cannot find the answer, give the customer service number on the back of your insurance card a call and ask if your plan is a POS plan.

What are the benefits of having a POS plan?

There are many benefits of having this type of insurance plan. Below are a few to keep in mind:

  • Lower in-network costs. By choosing a provider who is in-network, you will pay the least for your visit.
  • Out-of-network coverage. If you decide to visit an out-of-network provider, you will still have some coverage from your insurance plan.
  • Lowering costs by getting a referral - but not requiring a referral. By receiving a referral from your PCP, you might pay less for a visit to a provider. However, if you would rather save time and hassle, you can still see a provider without a referral (you’ll just have to pay more!).

What are the downsides of having a POS plan?

Like all insurance plans, there are also downsides to having this type of plan. Here are a few to keep in mind:

  • Varying rates by provider and referral status. With different rates per provider insurance status (in-network, out-of-network) and whether you have a referral, it can be confusing to understand what you’ll actually end up paying.
  • Paperwork implications. If you see a provider out-of-network, there might be a lengthy paperwork process in order to receive any of the coverage to which you’re entitled.

How do I know if a POS plan is right for me?

In order to determine if this type of plan is right for you, consider the following:

  • Your budget. When searching for plans, keep in mind the premium costs and the deductible to make sure these fit into your budget. Know that how much you’ll pay out-of-pocket is based on which provider you’re seeing and if you have a referral or not.
  • Administrative capability. If you’re comfortable with completing lengthy paperwork processes in order to see out-of-network providers, you’ll be just fine with this type of plan! However, if paperwork stresses you out, consider if this will hinder you from seeking care and if it’s worth it.
  • Your need for specialized care. If you know that you’ll want to see specialists, think through what referrals to ask your PCP for upfront - so you don’t have to keep going back in order to get more!

Overall, POS insurance plans offer flexibility and coverage for services like therapy. We’ve made it easy to find therapists in your area that accept POS insurance plans -remember, out-of-network therapists can still be covered by this type of plan, you’ll just have to figure out how much coverage your plan offers!