Enrollment
What Is a POS Health Insurance Plan?
- January 12, 2024
- Reviewed by John Krahnert
There are several different types of Medicare Advantage (Medicare Part C) plans, and each is categorized with a different acronym.
One type of Medicare Advantage plan is a POS plan.
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What does POS mean in Medicare?
“POS” stands for “Point of Service.”
A POS health insurance plan is a hybrid between an HMO and a PPO and combines some of the features of each.
- An HMO, or Health Maintenance Organization plan, utilizes a primary care physician to coordinate a patient’s care within the plan’s network of participating providers.
Medicare HMO plan members typically need to obtain a referral from their primary care doctor in order to schedule a visit with a specialist, and coverage is generally restricted only to the plan’s Medicare network. - A PPO, or Preferred Provider Organization plan, may or may not utilize a primary care doctor but members do not need to get a referral to see a specialist and coverage is not restricted to the plan’s network.
Care is not as coordinated in a PPO, so patients have more freedom of choice in the health care providers they wish to see.
How does a POS plan work?
A POS plan combines the lower costs found in an HMO with the out-of-network flexibility associated with a PPO.
You choose a primary care physician who will coordinate your care and issue referrals (like with an HMO), but you can still receive some coverage for care administered outside of the plan’s network (like you could with a PPO plan).
What are the benefits of a POS health plan?
The benefits of a POS Medicare Advantage plan include:
- Lower costs than a PPO
- Greater freedom of choice in health care providers than an HMO
While even PPO plans may restrict member coverage to geographical boundaries, POS plans are often accepted all over the U.S. This allows members to use their benefits even while traveling far from home.
POS plans keep a relatively small network of preferred doctors, hospitals and other health care providers and facilities, which helps keep plan premiums low.
What’s the difference between a POS and PPO plan?
POS and PPO may be easily confused by some Medicare beneficiaries. And while these two types of Medicare Advantage plans are related, they are in fact separate.
PPOs are among the most common types of Medicare Advantage plans, and they allow members to maximize their coverage by remaining in the plan’s network for care but still offering some coverage for out-of-network care.
A POS plan, however, may have even fewer network restrictions than a PPO plan.
What are the eligibility requirements of a POS Medicare Advantage plan?
POS plan eligibility is no different than that of most other types of Medicare Advantage plans.
You must be at least 65 years old in most cases, enrolled in both Medicare Part A and Part B and live in an area serviced by a POS plan.
When can you enroll in a POS health insurance plan?
Your best time to enroll in a POS Medicare Advantage plan is during either your Initial Enrollment Period (which begins three months before you turn 65 and continues for seven consecutive months).
You may also be able to join a POS insurance plan the fall Medicare open enrollment period, which lasts from October 15 to December 7 each year.
How can I find a POS plan near me?
Contact a licensed insurance agent to learn about the POS Medicare Advantage plan options available where you live or compare your plan options online.
POS plans are offered by many of the leading insurance carriers, and you may have numerous plans from multiple carriers from which to choose.
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.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.
Christian has written hundreds of articles for MedicareAvantage.com 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.
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@tzhealthmedia.com.
