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POS Plan: Pros and Cons


For maintaining physical as well financial well being, it is necessary to have at least some level of health insurance on a general scale. However, while choosing the right health insurance for you and your family, it is essential to understand the features of that particular type of insurance and its plan.
This becomes a necessity due to the financial risk you can face due to out-of-pocket expenses for medical care.

Choosing a managed care plan like a Point of Service (POS) plan can minimize that risk and at the same time provide you with flexibility and freedom of choices with your health insurance. However, before signing up for one, it is essential to know the pros and cons of a POS plan.
Pros of POS plan

  • When you visit a physician within the network, you have to make only nominal copayments or fees.
  • The copayment or fees per visit range from just $10-$25 when making such visit and varies according to the plan or the health insurance provider.
  • You don’t have to pay a deductible if you visit an in-network physician.
  • Out of network referrals can be made by your primary care physicians and they are covered by the plan.
  • Providers in the managed care network focus more on preventive medicine and can hence help you be in good health at all times and also catch various illnesses in the early stages.
  • The plan provides more flexibility and freedom of choice as compared to other managed care plans.
  • With a POS plan, your yearly out-of-pocket expenses are limited.

Cons of a POS plan

  • If you seek out-of-network care, you have to meet deductibles as well as incur charges for the care.
  • The out-of-network care sought by you can cost between 30%-40% of the charges incurred during that visit.
  • You need to get prior approval from your primary care physician in order to seek out-of-network medical care. Getting that approval can be time consuming and challenging.
  • The cost of a POS plan is slightly higher than a Health Maintenance Organization (HMO) plan.

Every individual’s need of health insurance is different and hence, different kinds of health insurance plans are suited to different individuals. If the pros of the POS plan outweigh its cons for you, it can definitely act as a choice for you.