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POS Health Insurance: Everything to Know

5 minute read

Rebecca Henderson

By Rebecca Henderson

Choosing the appropriate health insurance policy can be a confusing and daunting task for most folks. After all, medical bills can quickly cripple anyone who experiences health issues. It’s important to ensure you choose the right coverage. Sometimes that means paying higher premiums to have the best coverage for when you need it most. At the same time, navigating the particulars of a health insurance policy can make anyone want to run away from the process. We’re here to help clarify, by explaining a certain type of policy, known as POS health insurance. This type of health insurance includes built-in characteristics that will benefit certain types of policyholders. Then again, it might not be the right choice for everyone.

To help you learn more about POS health insurance (and decide if it’s right for you), we’ve put together this quick guide. You’ll learn what POS stands for, how it differentiates itself from other plans, and of course, the pros and cons of POS plans. At the end of it all, you should be able to decide whether a POS health insurance plan is right for you.

Ready to clear up the mystery of health insurance? Let’s get started.

What is POS Health Insurance?

Point of Service, or POS, health insurance defines itself by where you go to receive medical care. Typically most people think of a “point of service” for health needs as their local medical office. This is absolutely the case with a POS health insurance plan. It allows you to “pay less if you use doctors, hospitals, and other health care providers that belong to a plan’s network.” One basic requirement of a POS plan includes designating a primary care provider. That person will oversee your general health needs and can refer you to specialists as needed.

You might not have heard about POS health insurance plans, since they’re not often marketed as aggressively as other plans. However, these types of plans do “benefits patients who travel frequently” due to their national coverage. Premiums are typically cheaper than some of the other plan types we’ll discuss below. However, there are some important caveats too. Patients who seek treatment outside their network will have to file their own paperwork. They may also have to “pay most of the cost, unless the primary care providers has made a referral.” If you are someone who doesn’t see the doctor that often, a POS health plan could be the right choice for you.


Besides a POS health plan, there are also other kinds of health plans available.

A POS health plan is often considered a “hybrid of HMO and PPO plans.” An HMO, or health maintenance organization plan includes “low premiums and deductibles, and fixed copays for doctor visits.” Just like with a POS plan, you will have to designate a primary care provider — often known as a PCP. You would obtain referrals from your PCP to any specialists whose visits you don’t want to pay for out of pocket. HMO policies are usually great for anyone with few health problems. They are typically less expensive than other types of private health insurance.

An EPO, or exclusive provider organization plan, is also a mix between HMO plans and PPO plans. Cigna describes the EPO as “more pocket-friendly than a PPO plan” — unless you go out of network. Premiums are typically low while deductibles are high. Any visits outside of the network come straight out of your pocket.

Finally, PPO, or preferred provider organization plans have higher costs. However, they offer “a lot of flexibility to see the doctors you want.” You’re able to see specialists outside of your network without a referral, but you will pay a higher price than if you were to see someone within the network.

Pros of POS Health Insurance

When considering a POS health plan, know that there are certain characteristics you can easily take advantage of. For example, you can keep costs down by seeking care from in-network providers. If you don’t need to leave your network, your medical visits should be relatively affordable.

Paperwork can be a hassle at the doctor’s office, so it’s nice to know that a POS health plan will do all that for you. Plus, as long as you get a referral to any specialists you see, you shouldn’t be responsible for huge medical bills.

Drawbacks of POS Health Insurance

At the same time, there can be a few instances in which a POS plan might not work in your benefit. Depending on the network you’re a part of, you might have fewer choices when it comes to care providers. If you’ve gotten attached to a certain provider but have changed health insurance plans recently, you may not be able to go back to the same doctor if they’re not part of your new network.

Besides that, referrals can often take a few days (or even a week) to get from the doctor’s office to the specialist. If you’re someone who can’t wait for that process to happen, a POS plan might be a problem. Many doctor’s offices can’t schedule you until they receive a referral. That means your care may be delayed as a result.

Finally, the burden of medical bills falls heavier on your shoulders if you do see a provider that’s out of network. Not only will you have to pay more for a visit, but you’ll also have to take care of any associated paperwork yourself. This could mean requesting documents from your primary care doctor to share with your specialist.

Take Your Health Into Your Own Hands

We’re glad you’ve taken time out of your day to learn more about POS health insurance plans. These plans are great for certain types of people — specifically those who want to stick to a network of providers or those who have a small number of health problems. For others, a more robust health insurance plan might be a better choice. While this isn’t the final word on which plan could be the best for you, this guide should help you make more informed decisions regarding which health plans you choose in the future. After all, it’s your health we’re talking about.

POS Health InsuranceShutterstock
Rebecca Henderson

Freelance Writer

Rebecca Henderson has a Master's in German and a Bachelor's in Creative Writing. She alternates her time between writing and working on a variety of motorized projects. Most recently, she and her boyfriend have been building a custom drift trike. Rebecca believes that language, love, and a life worth living are only the first ingredients to happiness.


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