A POS, Point of Service, and an HMO, Health Maintenance Organization, are types of managed health care plans available in the U.S. The purpose of a managed health care plan is to provide affordable high-quality health care for its members. Health insurance options and benefits are similar for both a POS and an HMO, but there are some differences that distinguish each health care plan.
Considerations
If you have an HMO, you must get a referral from your primary care physician if you plan to receive medical care from physicians outside of the HMO's network of health care providers. A POS allows greater freedom to receive medical care from physicians other than your primary care physician by not requiring a referral, although it results in a higher cost.
HMO
An HMO a provide services for members within a certain geographic area by the HMO's network of health care providers, according to the U.S. Office of Personnel Management. HMOs complete the paperwork for your medical care and pay the cost of medical services that the health care plan covers.
POS
A POS is a service that an HMO provides to allow members the freedom to choose health care providers outside the HMO network, according to the U.S. Office of Personnel Management. Choosing a non-network health care provider results in a greater cost because members pay co-insurance and deductibles. Co-insurance is the percentage that a member pays after exceeding the amount of the health care plan's deductible. A deductible is the amount that an individual must pay out-of-pocket for medical care before the health care plan begins to pay for medical services.
Primary Care Physician
A managed health care plan pays greater insurance benefits if its members use doctors within the plan's network of health care providers. Both a POS plan and an HMO plan require members to choose one primary care physician from a network of doctors in their area who are under contract to the health care company. The primary care physician coordinates the medical care of the HMO member, while a POS member has the option of arranging their own medical care, according to Insurance.com.
Costs
HMO members face lower out-of-pocket costs when receiving medical care from a primary care physician by paying a low co-pay price with no deductible. Co-pays differ from co-insurance because they represent fixed costs for the services of a health care plan. A primary care physician under an HMO can help minimize a member's costs via a referral if a member needs to see a specialist such as a cardiologist, dermatologist or surgeon, according to Insurance.com. The referral is the HMO's statement that they will cover some of the costs for the non-network medical care, such as co-pay and deductible.
Members of a POS plan do not need a referral if they want to see another doctor within or outside of the POS network, although they can ask their primary care physician for a referral to minimize the cost.
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