Advantages and Disadvantages of Point-of-Service Health Plans

Point of Service (POS) plans are one of the many health insurance options available to you and your family. A unique type of health plan, point of sale plans can be thought of as a hybrid of the HMO and PPO plans. Point of sale plans contain certain characteristics of each of them, which some people may find beneficial. Below is an overview of the pros and cons of a point of sale plan compared to other plans.

Benefits of a point of sale plan

  • Not deductible. One of the most obvious benefits of a point of sale plan is its lack of deductibility for the physicians in your network. This means that you don’t have to make payments for your medical bills yourself before your insurance starts paying you back. PPOs, on the other hand, have franchises.
  • Low co-payments. Point of sale plans have lower co-payers than PPOs. When you have medical bills, you’ll only have to pay a small portion of them as a co-payment, and your POS plan will cover the rest.
  • More choice and freedom of choice. Unlike HMOs, point-of-sale plans offer partial coverage even for physicians who are not in your network. This means that if you are not happy with the choices available in your network for a certain medical treatment, you can see an off-network doctor and still have coverage.

Disadvantages of a point of sale plan

  • As part of a POS plan, you must choose a primary care provider (PCP). This physician serves as the primary physician for all medical needs. He can refer you to specialists in your network if you have a particular health problem. In order for a doctor’s visit to be covered as a network visit, you must go through your PCP to see a specialist.
  • If you see an off-grid doctor, you only have limited coverage. You have to pay a deductible and a higher co-payment than you would with the doctors in the network.

Choosing the right health insurance plan

If you are happy with the doctors in your network and don’t mind having a primary care provider that you need to go through for coverage, then a point-of-sale plan may be ideal for you. . Often, a PCP or the specialists they refer you to can cover all common medical needs. However, if you have any unique medical conditions that will require you to frequently see doctors outside of the point-of-sale network, you may be better off finding a plan that covers you with these doctors.

The greater choice and freedom of physicians, reduced co-payments, and the zero deductible for network physicians make POS an attractive option that you may want to consider. For more information on point-of-sale health insurance plans and other options available to you, please visit the Texas Health Insurance Company Option 1 Health website here.

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