PPO vs. POS Plans: What’s the Difference?

What is a PPO?

A PPO is possible because a selection of doctors and dentists agree to form a care network with an insurance company.² When the policyholder chooses a doctor, they can choose someone in or out of the network.

If the policyholder chooses an in-network provider with their PPO plan, they are more likely to receive a discount on services. They can still choose an out-of-network provider, but it may be more expensive for the same kind of services.³

What is a POS?

A POS is similar to a PPO, but it has specific differences. These plans are similar in the sense that they both create a community of providers for policyholders to work with. However, you can’t choose an out-of-network doctor as your primary care physician with a POS. Also, the policyholder must go through this physician to be referred to a specialist.⁴

Also, POS plans usually don’t have to meet a deductible, or dollar value paid out-of-pocket before accessing benefits.⁵

What’s the difference between a PPO and POS?

The main difference between PPO and POS insurance plans is that it’s more challenging to see an out-of-network provider in a POS.⁶ It is possible to see an out-of-network provider in a POS plan, but it will cost more money and you will have to do all the administrative paperwork yourself.⁷

However, there are a few other factors that differentiate PPO and POS health insurance plans:

• Costs: Typically, a PPO is more expensive than a POS. Sometimes, a POS can be half as expensive as a PPO.⁸
• Primary Care Provider: In a POS, you must choose an in-network primary care provider that provides your regular care and makes all your references for additional medical services. With a PPO, you can see whomever you’d like, but you may have to pay more if they are out of network.⁹
• Referrals: You can only see a specialist in a POS if your primary care physician refers you.¹⁰ In a PPO, you may have more freedom to see a specialist if you feel it is necessary.

Do I have to see in-network doctors with a PPO or POS plan?

As mentioned earlier, you must see providers within your network if you have a POS plan. If you need to see another provider, you may be required to get a referral from your primary care physician. With a PPO plan, on the other hand, you can visit out-of-network providers. Additionally, you don’t need referrals to do so.

Should I get a PPO or a POS plan?

The right type of health insurance plan for you can depend on your preferences, needs, and budget. If you’re willing to pay more for a plan with more flexibility, a PPO plan may be right for you. But if you want a less expensive plan and plan to stay in-network, you may consider a POS plan. Before you make a decision, be sure to review both types of health insurance thoroughly.

Supplemental insurance can complement your PPO or POS plan

Whether you have a PPO or POS, you may still be expected to pay out-of-pocket costs for necessary and preventative medical care. Aflac supplemental insurance is designed to help with those high medical expenses that major medical insurance doesn’t completely cover. Learn more about our products today, such as cancer insurance, critical illness insurance, and hospital insurance, to discover which plans can support you best.