A POS (Point of Service) plan is a type of health insurance that blends features of HMOs and PPOs. It gives you a primary care doctor who coordinates your care and requires referrals to see specialists, like an HMO, but also lets you go outside the plan’s network for a higher cost, like a PPO. About 9% of covered workers in the U.S. are enrolled in a POS plan as of 2025, making it less common than PPOs or high-deductible plans but still a meaningful option, especially at smaller employers.
How a POS Plan Works
The defining feature of a POS plan is the “point of service” choice you make every time you need care. At each visit, you decide whether to stay in your plan’s provider network or go outside it. Staying in-network keeps your costs low. Going out-of-network is allowed, but you’ll pay significantly more for it.
When you enroll, you choose a primary care provider (PCP) from the plan’s network. That PCP becomes your main point of contact for all non-emergency health needs. If you need to see a specialist, your PCP submits a referral to your insurance company before the visit. The referral takes effect immediately once submitted, and if you need to see a different provider in the same specialty at the same practice, a separate referral usually isn’t required.
Certain types of care don’t require a referral at all. You can typically see mental health providers, OB-GYNs, chiropractors, eye doctors, urgent care, and emergency services without one. Preventive services like annual physicals, routine vision and hearing exams, mammograms, and colonoscopies are also referral-free. Physical therapy, occupational therapy, speech therapy, telehealth visits, and lab work generally don’t need a referral either.
In-Network vs. Out-of-Network Costs
POS plans reward you for staying in-network. When you use your PCP and get proper referrals, you typically pay no deductible at all. Your costs are limited to copays for office visits and services.
The picture changes when you go out-of-network. Coinsurance kicks in, meaning you pay a percentage of the bill rather than a flat copay. You may also face a separate, higher deductible for out-of-network care. On top of that, out-of-network providers can bill you for the difference between what they charge and what your plan reimburses, a practice known as balance billing. The financial gap between in-network and out-of-network care in a POS plan can be substantial, so the flexibility comes at a real price.
The Paperwork Trade-Off
One detail that catches people off guard: when you use out-of-network providers, you’re responsible for filing the claims yourself. That means paying the provider upfront, keeping itemized receipts and medical bills, and submitting them to your insurer for reimbursement. In-network providers handle all of this billing directly with your plan, so you never deal with claim forms. If you regularly see out-of-network doctors, the administrative burden adds up.
POS vs. HMO vs. PPO
A POS plan sits between an HMO and a PPO in terms of both flexibility and cost. Here’s how the three compare:
- HMO: Lowest premiums. Requires a PCP and referrals. No coverage at all for out-of-network care (except emergencies). Least flexible.
- POS: Moderate premiums. Requires a PCP and referrals. Covers out-of-network care at higher cost. Middle ground on flexibility.
- PPO: Highest premiums. No PCP required, no referrals needed. Covers out-of-network care at higher cost. Most flexible.
The core trade-off is clear: a POS plan costs less than a PPO because it uses the PCP gatekeeper model to manage care, but it gives you an escape valve that an HMO doesn’t. If you have a specialist outside your network you want to keep seeing and don’t mind paying extra, a POS plan preserves that option.
Who Offers POS Plans
POS plans are primarily found through employer-sponsored insurance rather than the individual marketplace. About 12% of covered workers are at firms that offer at least one POS plan. They’re notably more popular at smaller companies: 19% of workers at firms with 10 to 199 employees are enrolled in a POS plan, compared to just 6% at larger firms. This likely reflects smaller employers looking for plans with moderate premiums that still give employees some out-of-network flexibility.
Who Benefits Most From a POS Plan
A POS plan works well if you’re comfortable having a primary care doctor manage your care and you rarely need out-of-network services, but you want the safety net of knowing you could go out-of-network if necessary. The no-deductible structure for in-network care keeps routine costs predictable, and the moderate premiums make it cheaper month-to-month than a PPO.
It’s a weaker fit if you frequently see specialists outside your network, since the combination of higher cost-sharing, balance billing, and claim-filing paperwork adds up fast. It’s also not ideal if you dislike the referral process and want to book directly with any specialist. In that case, a PPO gives you that freedom, though you’ll pay higher premiums for it.