PPO vs. POS Plans

There are several types of health insurance plans, and two of the most common types are PPO (preferred provider organization) and POS (point of service). Whether you’re getting insurance through an employer or the insurance marketplace, it’s important to understand the differences between PPO and POS plans so you can make the right decision for your needs. Aflac doesn’t offer primary health insurance, but we do offer supplemental insurance plans that work with your existing coverage to provide additional financial support.

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Table of Contents

Key Takeaways

PPO plans allow policyholders to choose in- or out-of-network doctors, but out-of-network doctors may be more expensive.¹
POS plans require you to see an in-network primary care provider and get a referral to see specialists.²
Aflac offers supplemental insurance plans that can support both PPO and POS plans by offering additional coverage for expenses.

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.¹ 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.¹

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.²

Also, POS plans usually don't have to meet a deductible, or dollar value paid out-of-pocket before accessing benefits.³

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POS vs. PPO: Key differences

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.³ 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.^1,3

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.³
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.³
Referrals: You can only see a specialist in a POS if your primary care physician refers you.³ In a PPO, you may have more freedom to see a specialist if you feel it is necessary.

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.

Other types of health insurance plans

Both PPO and POS plans can offer benefits, but they aren’t the only types of health insurance plans available. Two additional types of plans worth considering include:⁴

Health Maintenance Organization (HMO): This plan typically limits your coverage to care from in-network doctors. It may not cover out-of-network care except in an emergency, and will require a referral from a primary care doctor to see a specialist. These plans tend to focus more on prevention and wellness.
Exclusive Provider Organization (EPO): This managed care plan only covers services if you use doctors and specialists within the network. However, they don’t require referrals to see a specialist.

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.

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