There are many factors to take into account when selecting a managed health care plan, such as the state of your health, the cost of the plan and the benefits you will receive. There are many different kinds of plans to choose from, such as HMOs (health maintenance organizations), PPOs (Preferred Provider Organizations) and POS (Point of Service). With an HMO, member patients are required to see only those doctors and be treated in the hospitals or medical facilities in their HMO network. With a PPO plan, member patients can both choose doctors from within a network of affiliated doctors and also have the flexibility to see a medical service provider or use facilities outside of the network, but with out of pocket costs higher than with an HMO.
One of the advantages of a POS health care plan is that it mixes aspects of both an HMO and PPO so that the member patient has a wider range of choice. Like all managed care plans, POS is designed to provide patients with efficient, effective health care service that keeps costs as low as possible. Like an HMO, patients must turn to a network of preferred providers first unless it’s deemed necessary that they receive referrals to other providers. But, unlike an HMO, the POS patient can choose doctors or hospitals each time such care necessary. When a POS patient needs a referral, the POS-insured patient’s primary physician is authorized to make a referral to another physician who can be inside or outside the insurance company’s network, and the visit will be covered, although at a higher co-pay rate. With an HMO, visits to a doctor or medical service provider will not be covered unless there are very special circumstances. So while the insurance plan may be more expensive, a POS offers more flexibility and a less restrictive network.
A POS differs from a PPO in that a POS health care plan recommends that a member patient choose a personal physician from its approved providers network, but it is not a requirement. However, POS member patients who visit a specialist, especially one outside the network, without any referral from their personal physician may find they are not covered and will have to pay the full costs themselves. With a PPO health care plan, patients aren’t obligated to go through their personal physician to see a specialist or use other medical services outside the network, but while they are still covered, the co-pays tend to be much higher than under a POS plan.
In summary, a POS health care plan falls somewhere in the middle between a PPO and an HMO in terms of costs, flexibility, the ability to choose and the involvement of the network personal physician. For that reason, it’s one of the most popular of the managed care organizations especially for families and individuals with limited budgets.
