Few seem to know about POS plans
Though POS plans combine the best features of the other two options, they hold only a relatively small 9 percent share of the market, according to Consumer Reports.
One reason, say experts, is that POS plans are marketed less aggressively than other plans.
Also, price can be an issue. Though POS plans can be up to 50 percent cheaper than PPOs, premiums can cost as much as 50 percent more than for HMOs, says Rita Numerof, a St. Louis-based health care consultant. And POS out-of-network copays and deductibles can seem expensive. In-network, however, there are no deductibles for standard POS plans, and copayments are usually only $10 to $25, says Jeffrey Ingalls, president of Stratford Financial Group, an insurance consulting firm in Wayne, N.J.
On the other hand, POS plans can be up to 50 percent cheaper than PPOs, says Numerof, depending on the deductible. "However, the network is significantly smaller than for PPOs," she adds.
Costs aside, sorting through POS plan details can be challenging. Plans can be confusing, and many consumers don't understand what costs they're responsible for, says Numerof. Each plan has different deductibles, copays and even restrictions. "And, frequently, good information isn't available, so it's hard to compare apples to apples," she says.
But starting in 2014, when uninsured Americans will be required to buy health insurance or face a penalty under the Affordable Care Act's "individual mandate" provision, POS plans will become more transparent, Numerof says. They'll be sold on state insurance exchanges, where people will comparison-shop for insurance. Consumers will want to see detailed plan information to help them make informed choices.
Pluses and minuses of POS plans
Before buying a POS plan, consider these pros and cons.
- You can go out of network with relative ease. Because a POS plan is an HMO with out-of-network benefits, you can see any specialist, says Ingalls. POS plans also suit people who might use lots of outpatient medical services, such as counseling.
- You can enjoy more geographic flexibility. Travelers can visit doctors nearly anywhere and still have some medical coverage, says Brandon Beavers, vice president of group benefits provider CPActuaries in Norfolk, Va. "So when you have the flu, for example, you can walk into a care center," he says.
- If you live in a rural area or small town, you can benefit because your choices can be less limited than with an HMO, says Gregg Pajak, president of WizdomTree Benefit Solutions Inc. in Hauppauge, N.Y.