A POS plan blends HMO coordination with some out-of-network coverage.
A point-of-service plan uses a primary care physician to coordinate care, like an HMO, but pays for some out-of-network care at higher cost.
How a point-of-service plan blends HMO and PPO features
A point-of-service plan combines features of an HMO and a PPO. Members usually choose a primary care physician who coordinates their care and provides referrals to specialists. Care inside the network costs the least. Many POS plans also allow out-of-network care at a higher cost, which is where the PPO feature appears.
The mechanics matter. If an employee goes to a specialist without a referral, or goes out of network, the plan may pay at a lower level or not at all, depending on the design. The referral step and the out-of-network benefit differ from carrier to carrier, so two plans both called POS can behave differently.
POS plans are less common than HMO and PPO plans in some markets, and availability varies by carrier and county. Where they are offered they can sit between the HMO and the PPO on premium.
When we compare a POS plan we read the summary of benefits and coverage line by line, confirm whether referrals are required and what happens without one, and compare the out-of-network cost sharing with the PPO alternatives available to the same group.
What to decide and where it connects
Compare HMO
The narrower, referral-based option.
Compare PPO
The broader option.
Read the Parent Guide
HMO vs PPO vs EPO for Michigan employers.
Questions about this topic
What is a POS plan?
A hybrid plan that requires a primary care physician for referrals but allows some out-of-network care.
How does it differ from an HMO?
A POS plan pays for some out-of-network care. An HMO generally does not.
Is POS common?
Availability varies by carrier and region.
Ready? Send us your renewal, or talk it through with someone first. General information, not legal or tax advice.
Where these details come from.
HealthCare.gov: Health insurance plan types: Plain-language comparison of HMO, PPO, EPO and POS.
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We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
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