Advantages and Disadvantages of POS Plans
California POS (Point of Service)
This plan combines HMO and PPO characteristics. You must have a primary care physician, or PCP, but you can visit any other provider in your network, or a non-network provider.
Advantages:
- You can choose any network or non-network health care providers.
- You pay low fixed copayments for network care.
- Normally, there is no deductible for network care.
- You do not need a referral from your PCP for non-network care.
- Limits on total out-of-pocket expenses (copayments, coinsurance, and deductibles) are set; for example, your out-of-pocket cost for network providers in a given year might be capped at $2,400 for an individual or $4,000 for a family.
Disadvantages:
- You need a referral from your PCP to see a specialist within the network.
- Your cost for non-network care could be high.
- You will likely pay a yearly deductible (about $300 for an individual, $600 for a family) for non-network care before your insurance kicks in.
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