Advantages and Disadvantages of Point of Service Health Plans


Point-of-Service (POS) plans are one of many health insurance options available to you and your family. A unique type of health plan, POS plans can be considered a hybrid of HMO and PPO plans. The POS plans contain some features of each of these, which some people may find advantageous. Below is a summary of the advantages and disadvantages of a POS plan compared to other plans.

Advantages of a POS Plan

  • Non deductible. One of the most obvious advantages of a POS plan is the lack of deductibles for doctors in your network. This means that you do not have to make any payments for your medical expenses on your own before your insurance begins to reimburse you. PPOs, on the other hand, have deductibles.
  • Low copays. POS plans have lower copays than PPO plans. When you have a medical expense, you only have to pay a small part as a copay, and your POS plan will cover the rest of the cost.
  • More options and freedom to choose. Unlike HMOs, POS plans provide partial coverage even for doctors who are not in their network. This means that if you are not satisfied with the options available in your network for a certain medical treatment, you can see an out-of-network doctor and still have some coverage.

Disadvantages of a POS plan

  • Under a POS plan, you must choose a primary care provider (PCP). This doctor serves as your primary care physician for all medical needs. He or she can refer you to specialists in your network if you have a specific health problem. For a doctor’s visit to be covered as an in-network visit, you must see your PCP to see a specialist.
  • If you visit a doctor outside of the network, you only have limited coverage. You must pay a higher deductible and copays than you would with in-network doctors.

Choosing the right health insurance plan

If you’re happy with the doctors in your network and don’t mind having a primary care provider to go to for coverage, then a POS plan may be right for you. Often a PCP or the specialists they refer you to can cover all common medical needs. However, if you have unique medical conditions that will require frequent visits to doctors outside of the POS network, it’s best to find a plan that covers you with those doctors.

Greater choice and freedom from doctors, lower copays, and zero deductible for in-network doctors make POS an attractive option you may want to consider. To learn more about POS health insurance plans and other options that are available to you, visit the Texas Option 1 Health insurance company website here.