What’s in a Point of Service (POS) Plan?

People can choose from a variety of health and dental insurance plans. Some of these plans include HMO and PPO plans. Both of these plans have their caveats and benefits. For instance, people in HMOs pay cheaper premiums but must remain in-network. Meanwhile, people in PPOs pay higher premiums but can visit their preferred doctors, even when out-of-network. Alternatively, people can enroll in Point of Service (POS) plans.

How POS Plans Work

POS plans have their own caveats, but they can also benefit people. These policies contain terms and conditions similar to those in HMOs and PPOs. For instance, beneficiaries in both POS and HMO health insurance policies usually need to visit a primary care physician (PCP), who would refer them to any specialists in their policies’ network. In some POS policies, beneficiaries usually do not have to pay a deductible for procedures performed by a PCP, and preventive care benefits are usually included.

Unlike an HMO health plan, POS health plans allow beneficiaries to visit out-of-network providers for less coverage. People must still pay co-payments, coinsurance, and an annual deductible. People may be responsible for high deductibles when visiting out-of-network providers, so patients who use out-of-network services will pay the full cost of care out of pocket until they reach the plan’s deductible. Fortunately, when a PCP refers the patient to an out-of-network specialist, the POS plan will pay more toward an out-of-network service. Also, beneficiaries can take advantage of the plan’s nationwide coverage to receive benefits for visiting physicians in other places.

Premiums for POS plans are usually lower than premiums for PPOs, but they are usually higher than premiums for HMOs. Like POS health plans, POS dental plans also allow beneficiaries to visit out-of-network dental providers. When people visit those providers, they are still responsible for their deductible, co-insurance, usual and customary fees, and benefit limitations. POS dental plans can reimburse their beneficiaries based on a low table of allowances; with significantly reduced benefits than if the patient had selected an in-network provider.

POS plans represent another option for people who want certain benefits from their insurance. Although they cost more than HMO plans, they can benefit those who want to visit out-of-network providers and pay less than PPO plans.

If you are struggling with insurance plans, whether HMO, PPO, or POS, consider partnering with eAssist. Our Success Consultants are familiar with various types of coverage and will ensure your claims are billed correctly. To learn more schedule a consultation.

Dr. James V. Anderson

CEO & Co-Founder, eAssist

Dr. James Anderson is a practicing dentist and the CEO and Co-Founder of eAssist Dental Solutions, the nation’s leading platform for dental billing. A serial entrepreneur, Dr. Anderson has built multiple successful ventures, including eAssist and nine dental practices in Utah, all driven by his mission to help dentists, their teams, and their patients achieve peace of mind. He co-founded eAssist in 2011 to give dental practice owners the ability to fully outsource their billing departments—a vision that now serves over 2,400 practices nationwide. Under his leadership, the company has formed strategic partnerships with the California Dental Association and Henry Schein, and earned a spot on the Inc. 5000 list for nine consecutive years. In 2020, Dr. Anderson was recognized as Entrepreneur of the Year by Business View Magazine and ranked among the top entrepreneurs in the country by Entrepreneur Magazine. He holds a B.S. in Finance from Brigham Young University, a D.M.D. from Oregon Health & Science University, and completed the three-year O.P.M. program at Harvard Business School. He also serves as Chairman of the Dental MBA Advisory Board at Roseman Dental School.