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What are PPO and POS Plans?

Health insurance can come in a variety of different forms. PPO (preferred provider organization) and POS (point of service) are two common types of plans.1 Understanding the differences between PPO and POS plans may help you make the right decision for your needs. Let’s review how each type of health insurance plan functions more in-depth.

If you are getting an insurance plan through your employer, you may not be able to choose between a PPO and POS. However, if you are buying health insurance through the insurance marketplace, you can decide whether you want a PPO or POS.

It’s important to note that Aflac does not offer primary health insurance but supplemental insurance plans that work with your existing coverage to create better support. We complement a variety of health insurance plans, including PPO and POS plans.

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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.

Supplemental Insurance to 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 to discover which plans can support you best.

Still have questions?

Explore your supplemental health insurance options.

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