|
 Printer  Email
Point of Service Plans Explained
Because Point-of-Service plans are managed care hybrids similar to HMOs and PPOs, you may want to read up on the latter two before going further.
Same Managed Care, More Choices
For the most part, POS plans are based on the same managed care principles as HMOs; you're offered lowered medical cost in return for limited choice. Your costs are similar, and you need to choose a network-based physician as your primary healthcare provider. And just like a PPO, POS plans provide access to partial coverage whenever you use out-of-network healthcare services.
By making use of what's called a two levels of benefits system (in plan and out of plan), POSs have become a remarkably popular health insurance option over the last few years. POS plans allow you to choose how, when and where you receive your benefits, giving you a substantial amount of control over your out-of-pocket expenses.
So, What's the Difference?
It's all sounding good, but keep in mind these important differences between POS coverage and other managed care plans:
Advantages of POS Coverage
- You're not limited to HMO in-network providers.
- Your in-network care co-payments are low and there won't be a deductible.
- Your annual out-of-pocket costs are limited.
- Youıll have the maximum amount of freedom., especially compared to other managed care plans,
- You probably wonıt need a referral from your primary care doctor if you need emergency or urgent care.
Disadvantages of POS Coverage
- The co-payments for your out-of-network care are higher than average.
- A deductible is applied to your out-of-network care.
- You may have problems getting referrals to specialists.
- If you're traveling outside of your networkıs area or have a dependent living outside the network area, the same rule will be applicable. But, those benefits will cost you more out-of-pocket.
- You're required to select a primary care physician, but you wonıt be limited to in-network services. You have the option of visiting a specialist or alternate care giver from outside your POS Network.
What About the Cost?
The general cost breakdown of your POS Plan is similar in most respects to other managed care plans. In fact, though more expensive than an HMO, your POS coverage could wind up being cheaper than a comparable PPO because your health insurance carrier will be regulating most of your health care services. But, that level of control will work to reduce the cost of your POS Plan.
Be sure to ask as many questions as you need, and if the POS plan you're considering doesnıt satisfy you, keep looking.
|
