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What is POS insurance?

sporty woman health insurancePOS Insurance is an acronym for Point of Service Insurance. Point of Service insured is a unique type of health insurance coverage that combines many of the benefits of both Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).

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POS plans generally have lower deductibles and co-pays compared to both HMOs and PPOs. However, POS plans do have a network of care providers including physicians and hospital, just like an HMO plan does. The difference is that POS plans also require the insured to have a primary care doctor who helps manage the overall care plan of their patients.

In a POS plan, you can also see specialists that are part of the network. However, in order to see a specialist in a POS, your primary care physician must give you a referral. The referral must be to an in-network specialist.

POS plans also have very limited coverage if you go to a physician that is out of network. This is primarily because since the POS insurance company does not have a professional relationship with an out of network provider, they do not have a firm grasp as to what the reimbursement expectations will be.

Most POS insurance companies offer a substantial number of specialists, so it is best to utilize an in-network provider. This not only save you and the insurance company money, but will also make coordinating your care simpler and more efficient.

What are the benefits of a POS insurance plan?

Some of the benefits of a Point of Service plan include the ability to see a doctor that is out of network. Although this option may be more expensive, at least it is an option for members. There may be a specialist that is vital to your care but is just not in-network. A POS plan allows you to still see that specialist and receive a small amount of coverage.

In an HMO plan, there is no option of seeing an out-of-network practitioner. While this keeps costs down, sometimes it is best for the care and treatment of the individual if there is an option to see any physician.

Is there any reason not to sign up for a POS insurance plan?

A POS insurance plan is more beneficial than most state or federally sponsored health insurance plans. Individuals and families get complete coverage with a POS insurance plan, and while the coverage through state plans might be limited.

For example, state and federal plans do not offer comprehensive prescription medicine coverage, and certain benefits might be limited including hospital stays and elected surgeries. In most cases, if you have the ability to be part of a POS plan, it is a good choice.

Do POS insurance plans provide preventative care?

Yes, most POS insurance plans will provide coverage to you and your family for preventative care. This includes yearly physicals for adults, well-child visits for children and annual visits to the OB/GYN for women.

Most POS insurance plans find a lot of value in preventative care and try to make it as affordable as possible by having lower co-pays for preventative visits. This is simply because it is less expensive for insurance companies offering POS health plans to pay for preventative care than to pay for the care required from a lack of preventative care.

For example, it is cheaper to pay for a yearly doctor visit than multiple surgeries and hospital stays as well as the cost associated with prescription medications.

Are there ways to keep my prescription medication costs down?

It is important to always speak to both your doctor and your pharmacist about your prescription medications and how to best manage them.

More and more medications are becoming available in generic form. These medicines contain the exact same active ingredients as the brand name, but are not packaged and marketed by large pharmaceutical companies. Therefore, the costs are lower to produce, and those savings are passed on to the customers.

You can also discuss with your doctor if there are any over the counter medications have the potential to be just as effective as a prescription medication. Many companies are creating medicines that used to be prescription only, but are now available over the counter.

Finally, don’t be hesitant to ask the pharmacist if there are different medications available that may be less expensive and just as effective.

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