PPO vs POS What's The Difference

PPO vs. POS Plans: What’s the Difference? In general, the biggest difference between PPO vs. POS plans is flexibility. A PPO, or Preferred Provider Organization, offers a lot of flexibility to see the doctors you want, at a higher cost. POS, or Point of Service plans, have lower costs, but with fewer choices. There are many more details you’ll want to compare, as well.

What are the main differences?

When you’re comparing health plans it’s important to understand what sets them apart from one another. This way you can make a decision based on your needs. Here are some main features that you can compare to find out what makes a different:

  • Costs (deductibles, coinsurance, copay’s, and premiums)
  • Primary Care Provider (PCP) requirement
  • In-network requirement
  • Referrals to other providers

Comparing costs between PPO and POS

Deductibles: PPO plans usually come with a deductible. This means you pay for care and services until the deductible is met. Then your plan starts sharing costs. POS plans typically do not have a deductible as long as you choose a Primary Care Provider, or PCP, within your plan’s network and get referrals to other providers, if needed.

Coinsurance: You may be required to share some of the costs for your care with both a PPO and POS plan. For a PPO plan your coinsurance kicks in once you’ve met your deductible. With a POS plan, coinsurance costs could kick in if you need out-of-network care or fail to get referrals to see other providers.

Copays: Both PPO and POS plans may require copays. This is a fee you pay to a doctor at the time of the visit or for prescription medication.

Premiums: This is what you pay monthly for your plan. Typically you will have a higher premium with a PPO because it offers more options. The POS plans usually have lower premiums because they offer fewer options

Comparing costs between PPO and POS

Some health plans require you to choose a Primary Care Provider. A PCP can serve as a home base for care. They get to know you and your health needs and can coordinate care with other specialists when needed. 

PPO plans do not require you to choose a PCP, but it’s recommended. Referrals to specialists are also not required.

POS plans require you to choose a PCP and to get referrals if you need to see other providers, except for OB-GYNS. In fact, “point of service” means that your PCP is your initial point of service. If you need to see specialists or get any other care, your PCP will coordinate it.

Comparing costs between PPO and POS

PPO plans do not require you to see in-network doctors and you don’t need referrals, either. If you choose to see providers outside the network you will pay more because coverage is lower.

With a POS plan, you would be required to see your in-network PCP. As your point of service doctor, they would have to refer to any other provider if needed, in order for you to receive coverage under your plan.

Comparing costs between PPO and POS

If you’re looking for a lot of choice and flexibility, you might consider a PPO. No PCP required, no referrals, and coverage for both in- and out-of-network providers. This choice and flexibility come with higher plan costs, though.

POS plans cost less but offer fewer choices. If you’re not concerned about having to stay in-network, choosing a PCP, or getting referrals for other providers, then a POS plan may work for you.

Before choosing any health plan, make sure to review the details of coverage. These are high-level descriptions of PPO vs POS plans. Plans can vary widely between insurance carriers.