WHAT ARE POS AND PPO HEALTH INSURANCE? COST AND BENEFITS
With insurance costs constantly rising, it helps to know the basics of the various health insurance plan structures available today. Let’s look at POS and PPO health insurance because these are the two plans we decided on for the new year.
One of the things I dread every fall is the renewal of our health insurance plan. Our current plan can never be renewed with exactly the same terms. something is always premium, deductible, maximum out-of-pocket amount, terms of service, etc. change of.
The positive thing about the open enrollment season is that it is a learning experience, as insurance is constantly evolving. So, below I’ve put together a simple guide on what I’ve learned about POS plans, how they differ from PPO plans, and a real side-by-side example of POS vs PPO plan comparison.
What is POS Health Insurance?
When I first told Sam I was looking at a new option called the POS plan, the first thing that came out of his mouth was, “What is this, a Piece of Sh- plan?” it happened. haha. While many of us have had experiences that feel like part of our health insurance, having some form of health insurance in the US is a must.
The costs are ridiculous to not have at least basic coverage. However, even having a solid insurance plan can leave you with a huge balance bill when you least expect it. For example, when I got $3532, I had to fight tooth and nail for 11 months. ambulance surprise bill.
Fortunately, I pushed until my insurance covered most of it, and that surprise bill was resolved. But it was a very stressful journey that opened my eyes to the world. corrupt EMS system.
Anyway, the Point of Service plans is a hybrid of HMO + PPO. These are “affordable” managed healthcare plans that come with out-of-network benefits. In other words, you can use them like an HMO or PPO. A little strange, isn’t it?
Most POS plans require a referral from a primary care physician (PCP) before seeing a specialist. This is the HMO direction. However, since POS plans cost more than HMO plans, you can access out-of-network (OON) doctors. This is the PPO aspect.
But of course, the OON doctor’s claims will cost you more than if you were still waxing. It’s nice to have access to out-of-network benefits if needed.
How is a POS Different from a PPO?
The two biggest differences between POS and PPO plans are flexibility and cost. The more flexibility you want, the more you have to pay. PPO plans offer the most flexibility and thus have the highest premiums. POS plans cost less than PPOs because they offer fewer options.
However, there is more to consider when choosing between a POS and PPO plan than the monthly premium cost. You’ll also want to look at the cost of deductions, co-payments, and coin security. Most PPO plans have deductibles, whereas many POS plans don’t if you use an in-network PCP and get referrals to see other providers as needed.
However, Copays are common in both POS and PPO plans. They tend to be similar in cost within the same metal layer. The difference in copay costs between these plan types may not be significant unless you have a large number of appointments each year.
You’ll also often see money security on both POS and PPO plans. However, if you stay within the network and seek advice for experts with a POS plan, you can avoid money laundering.
If you go with a POS plan, you’ll get the best value if you have a PCP that you really like and will see for referrals. If not, a PPO plan will help you avoid redirects and completely need a PCP if you don’t want to.
Can a POS Plan Be HDHP and HSA Eligible?
yeah! HDHP (Highly Deductible Health Plan) and HSA ( Health Savings Account ) are eligible.
This may allow you to take advantage of using pre-tax dollars for qualifying medical expenses. Using an HSA can usually save around 30% depending on your circumstances.
If you have employer-sponsored health insurance benefits, ask if they offer employer-funded HSA contributions. If you can find an HSA-friendly plan that meets your needs, it’s a good way to lower your overall healthcare costs.
Related: How Can Early Retirees Get and Pay for Health Insurance?
Example of a POS and PPO Plan
Here is a real POS example and a side-by-side PPO plan for a family of four.
If the sticker price surprises you, if you have to pay 100% alone with no employer or government subsidy, that’s how much Gold health insurance plans cost. The Average Cost of Family Health Insurance is incredibly high in the US.
Note that this is just an example. There are dozens of nuances from one POS and PPO plan to another. However, this comparison chart can give you a general idea of how a POS and PPO plan can stack up against each other.
The abbreviations in the table are as follows:
- Individual = Individual
- family = family
- In = Waxing
- Out = Out of Network
- Ded = Downloadable
- OOP = Out of Pocket
- NC = Not Included
- PT = Physical Therapy
- OT = Occupational Therapy