Point of Service (POS) plan
Updated for plan year 2026
In plain terms
A Point of Service (POS) plan blends features of an HMO and a PPO. Like an HMO, it's built around a primary care doctor who coordinates your care and provides referrals to specialists. Like a PPO, it offers some coverage for out-of-network care, usually at a higher cost than staying in network. Premiums tend to land between HMO and PPO levels. A POS plan suits people who want a coordinated network plan but also want a partial safety net for going outside it.
A plain example
Your POS plan covers in-network care fully through your primary doctor's referrals. When a specialist you want is out of network, the plan still pays part of the cost, say 60 percent of the allowed amount after a higher out-of-network deductible, provided your primary care doctor referred you. Without that referral, your out-of-network share climbs further.
Why it matters
A POS plan can be the right shape if you mostly stay in network but want the option to reach outside it without losing all coverage. The catch is that the HMO-style referral rules still apply, so the out-of-network benefit often hinges on going through your primary care doctor first.
A common point of confusion
A POS plan isn't a referral-free PPO. The out-of-network coverage usually still depends on getting a referral from your primary care doctor, so skipping that step can cut your benefit even on care the plan would otherwise help pay for.