What Is a POS (Point of Service) Health Insurance Plan?

Christian Worstell
In this article...
  • A point of service (POS) health insurance plan can offer more flexibility to beneficiaries than Medicare HMO and PPO plans. Learn more about these plans and how they work.

A POS health insurance plan is one of several different types of available plans, each with its own structure of allocating costs and coverage. 

POS is an acronym that means “Point Of Service.” In this Medicare plan guide, we discuss what Medicare POS plans are and how they work.

What Does POS Mean in Medicare?

POS means in Medicare the same as what it means in more traditional health insurance.

A POS Medicare Advantage plan operates much like a POS health insurance plan offered by an employer or purchased on the Marketplace or private market. 

A POS plan is similar to a cross between an HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) plan:

  • POS plans use a primary care physician to coordinate care within the plan’s network and issue referrals for specialist visits, much like an HMO.

  • But like a PPO plan, a POS allows members to receive some coverage when seeking care outside of the plan’s provider network.

How Does a POS Plan Work?

POS Medicare Advantage plan members choose a primary care physician who will coordinate care within the network. You may elect to visit those in-network doctors, choose other providers within the network or seek care outside of the network.

If receiving care outside the network, any covered services are typically covered at a reduced level. You may face a higher deductible for out-of-network care, and your POS plan may require you to submit claims for care received out-of-network.  

If you wish to see a specialist, you may need to obtain a referral from your primary care physician, depending on the rules of your plan.

What Are the Benefits of a POS Health Plan?

POS plans generally use a small network of providers which in turn can keep premiums low. Copayments for provider visits are also typically on the lower side compared to other types of Medicare health plans. 

Another benefit a POS plan is the freedom and flexibility to exercise greater control over the health care providers you see. POS plan members can go outside of the plan’s designated network to receive care and still have the services or items covered, albeit at typically a lesser rate.

POS plans generally don’t have geographic limitations as many PPO plans do.

What’s the Difference Between a POS and PPO Plan?

It’s easy to understand why PPO and POS health insurance plans can be easily confused. But while POS plans share some of the qualities of PPO plans, they are indeed two different types of health insurance plans. 

Both types of plans allow members to seek care outside of the plan’s network and still receive some coverage. The main differences between POS vs. PPO plans are:

  • POS plans typically cost less than PPO plans.

  • POS plans use a primary care physician who coordinates care. PPO plans do not require the use of a primary care physician. 

  • Unlike most PPO plans, POS plans may require members to obtain a referral from a primary care physician in order to visit with a specialist. 

PPO and HMO plans are the most popular types of Medicare Advantage plans, with POS plans accounting for a much smaller share of Medicare Advantage plan enrollment.

Who Is Eligible For A POS Medicare Advantage Plan? 

In order to enroll in a POS Medicare Advantage plan, you must meet each of the following criteria.

  • Be enrolled in Medicare Part A and Part B
  • Be at least 65 years old (in most cases)
  • Live in the area serviced by the plan

When Can You Enroll In A POS Health Insurance Plan? 

You can enroll in a POS Medicare Advantage plan during your Medicare Initial Enrollment Period, which typically begins three months before you turn 65 and ends three months after your 65th birthday month.

You may also enroll during the fall Medicare Open Enrollment Period, which takes place between October 15 and December 7 each year.   

How Do I Enroll In A POS Health Insurance Plan?

Contact a licensed insurance agent to learn about the POS Medicare Advantage plan options available where you live.

Most Medicare beneficiaries have numerous plan options available to them and an agent can help you decipher which plan may be best for your needs and guide you through the enrollment process.

Christian Worstell
About the Author

Christian Worstell is a senior Medicare and health insurance writer with HelpAdivsor.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

While at HelpAdvisor, Christian has written hundreds of articles that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. You can find Christian’s most recent articles in our blog.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@MyHelpAdvisor.com.

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