Elizabeth Rivelli has nearly five years of experience covering insurance for finance publications. She has expertise in various insurance lines, including car insurance, health insurance, travel insurance, life insurance and others. In her writing, s.
Elizabeth Rivelli Insurance WriterElizabeth Rivelli has nearly five years of experience covering insurance for finance publications. She has expertise in various insurance lines, including car insurance, health insurance, travel insurance, life insurance and others. In her writing, s.
Written By Elizabeth Rivelli Insurance WriterElizabeth Rivelli has nearly five years of experience covering insurance for finance publications. She has expertise in various insurance lines, including car insurance, health insurance, travel insurance, life insurance and others. In her writing, s.
Elizabeth Rivelli Insurance WriterElizabeth Rivelli has nearly five years of experience covering insurance for finance publications. She has expertise in various insurance lines, including car insurance, health insurance, travel insurance, life insurance and others. In her writing, s.
Insurance Writer Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
| Deputy Editor, Insurance
Updated: Feb 15, 2024, 5:41am
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Choosing the right plan for your needs can be challenging if you’re in the market for health insurance. There are multiple types of health insurance available, which differ in terms of features like out-of-pocket costs, network size and covered medical services.
While you might be familiar with common plans, like health maintenance organization (HMO) plans and preferred provider organization (PPO) plans, it’s also worth considering a lesser-known plan, like Point of Service (POS). In this guide, we’ll explain the basics of POS health insurance, including how much this plan costs, how it works and how it compares to more popular plans.
POS plans are health insurance that combines elements from an HMO and PPO.
With a POS plan, you can receive care from an in-network or out-of-network provider, but you pay less for going in-network. It’s similar to the PPO model in that respect.
Most POS plans require you to work with a primary care provider to coordinate your treatment and get a referral if you want to see a specialist. This is similar to the way an HMO works.
POS plans contract with a network of doctors, specialists and healthcare facilities. Providers in the network agree to get paid a discounted rate for the services they provide to plan members. When you visit an in-network provider, your health insurance company pays most of the bill once you reach your health insurance deductible.
With a POS plan, you’re allowed to go out-of-network for treatment. The catch is that your insurance company pays a much smaller portion of the bill. While POS plans offer the flexibility to see providers that are in-network and out-of-network, you pay the lowest amount if you receive care from an in-network provider.
The only exception to this rule is emergency care. If you need to visit the emergency room or an urgent care clinic, your POS plan will provide the highest level of coverage, whether the facility is in-network or out-of-network.
Before receiving specialty care with a POS plan, you need to visit your primary care provider and get a referral. Examples of specialists are dermatologists, physical therapists and cardiologists. You’re typically required to select a primary care doctor in the plan’s network when you initially enroll.
The average monthly cost of a POS plan is $505 for 30-year-olds, $568 for 40-year-olds and $794 for 50-year-olds on the Affordable Care Act (ACA) marketplace.
The cost of a POS health insurance plan on the ACA marketplace depends on multiple factors. Some of the factors that impact your health insurance premium include:
In addition, your plan’s costs depend on where you’re getting coverage. For example, individual health insurance plans purchased directly from an insurance company differ in price compared to ACA marketplace plans. If you can get a POS plan through your employer, you can expect to pay a much lower rate, given that employer-sponsored plans have subsidized premiums.
If you qualify, another option is to get an ACA marketplace plan that’s subsidized. The ACA provides subsidies and premium tax credits that can lower the cost of health insurance for people with household income at below 400% of the federal poverty level.
Here are the average rates for POS plans in the ACA marketplace by a person’s age and situation.
