In general, the biggest difference between PPO vs. POS plans is flexibility. A PPO, or Preferred Provider Organization, offers a lot of flexibility to see the doctors you want, at a higher cost. POS, or Point of Service plans , have lower costs, but with fewer choices. There are many more details you'll want to compare, as well.
PPO vs. POS: What are the main differences?
When you're comparing health plans it's important to understand what sets them apart from one another. This way you can make a decision based on your needs. Here are some main features that you can compare to find out what makes a PPO different from a POS:
Comparing costs between PPO and POS
When it comes to the costs for PPO vs. POS plans, how do they stack up?
- Deductibles: PPO plans usually come with a deductible. This means you pay for care and services until the deductible is met. Then your plan starts sharing costs. POS plans typically do not have a deductible as long as you choose a Primary Care Provider (PCP) within your plan's network and get referrals to other providers, if needed.
- Copays: Both PPO and POS plans may require copays. This is a fee you pay to a doctor at the time of a visit or for a prescription medication.
- Coinsurance: You may be required to share some of the costs for your care with both a PPO and POS plan. For a PPO plan, your coinsurance kicks in once you've met your deductible. With a POS plan, coinsurance costs could kick in if you need out-of-network care or fail to get referrals to see other providers.
- Premiums: This is what you pay monthly for your plan. Typically you will have a higher premium with a PPO because it offers more options. The POS plans usually have lower premiums because they offer fewer options.
FAQs
PPO plans do not require you to choose a PCP, but it's recommended. Referrals to specialists are also not required. POS plans require you to choose a PCP and to get referrals if you need to see other providers, except for OB-GYNS.
What do PPOs and POS have in common? ›
Both PPO and POS plans have provider networks. In these networks, providers contract with the insurance company for payment. Both plans have many of the same types of costs, including premiums, copays and coinsurance.
What is a disadvantage of a POS plan? ›
High Deductibles for Out-of-Network Coverage
One major disadvantage of POS plans is that their deductibles for out-of-network care tend to be quite high.
What are the principal differences among HMO PPO and POS plans? ›
In a nutshell, these summaries generally say that HMOs and POS plans require a referral from a primary care doctor in order to see a specialist, while PPOs and EPOs do not, and that PPOs and POS plans cover out-of-network care, while HMOs and EPOs do not.
What is the disadvantage of a PPO? ›
What Are Disadvantages of PPO Plans? PPO plans tend to be more expensive than other managed-care options. They typically have higher monthly premiums and out-of-pocket costs, like deductibles.
Why do people choose PPO plans? ›
PPOs Usually Win on Choice and Flexibility
If flexibility and choice are important to you, a PPO plan could be the better choice. Unlike most HMO health plans, you won't likely need to select a primary care physician, and you won't usually need a referral from that physician to see a specialist.
What are 3 benefits of a POS? ›
In general, a POS system helps you improve your operations for your customers. This includes reducing waiting time, faster scanning of items, quicker payments, etc. With these operational improvements, customers will tend to get better service and come back to your store for their next purchase.
What is the problem of POS? ›
Network issues are a frequent POS system problem that can disrupt your business operations and communication. They can include issues such as poor connectivity, slow speed, or downtime. Network issues can cause loss of data, reduced functionality, or inability to process transactions.
What is not a benefit of POS plan? ›
A Point-of-Service plan, which combines elements of both Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans, provides certain advantages but does not ensure automatic acceptance for all applicants.
Should I get HMO or POS? ›
POS: An affordable plan with out-of-network coverage
For slightly higher premiums than an HMO, this plan does cover out-of-network doctors. But you'll pay more. This is an important difference if you are managing a condition and one or more of your doctors are not in the network.
A type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network.
Should I have HMO or PPO? ›
HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.
What does POS mean in insurance plans? ›
A type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. POS plans also require you to get a referral from your primary care doctor in order to see a specialist.
Which is better a PPO or an advantage plan? ›
Essentially, Medicare Advantage HMO and PPO plans have around the same costs covered for essential medical services. This includes copayments, coinsurance, deductibles, and your monthly premium and Part B premium. However, HMO plans usually have lower monthly premiums than PPO plans.
What is not a benefit of a POS plan? ›
A Point-of-Service plan, which combines elements of both Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans, provides certain advantages but does not ensure automatic acceptance for all applicants.
What is better than PPO? ›
The monthly payment for an HMO plan is lower than for a PPO plan with a comparable deductible and out-of-pocket maximum. CareFirst's PPO plans offer a wide network of providers. In exchange for a lower monthly payment, an HMO offers a narrower network of available doctors, hospitals and specialists.
