Facts about PPO and POS Plans
- According to the Henry J. Kaiser Family Foundation, more than 8.8 million people were covered under POS plans in 2010, whereas over 53 million people had PPO plans during the same year. Over 135 million people had a managed health care plan in 2010, which was up from 126 million in 2009.
- Members of POS and PPO health insurance plans are provided with a network of physicians who have been contracted to perform health services at discounted rates. By receiving medical care in-network, POS and PPO members receive higher insurance benefits and pay lower out-of-pocket expenses.
- A POS plan is considered a hybrid plan as it combines elements from both HMO and PPO plans. POS members can pay little or no deductibles and small co-pay amounts by staying in-network for care. Also members of some POS plans are required to choose a Primary Care Physician (PCP). A PCP is a doctor who acts as a gatekeeper by coordinating his patient's medical services. PCPs are authorized to refer their patients to other doctors and specialists if the medical visit is deemed necessary. However, POS members can still visit a non-network physician without a referral from their PCP and still receive insurance coverage.
- PPO plans are the most flexible of the three managed health care plans. Members can pay less out of pocket when receiving care within their provider network. Unlike HMO and some POS plans, PPO plans do not require their members to choose a PCP. They are able to see doctors in and out of network and still receive insurance benefits. However, their insurance benefits are lower for non-network care.
- Both POS and PPO members can experience substantially higher out-of-pocket expenses when they seek out-of-network care compared to in-network providers. PPO members can expect to pay up to almost half of their out-of-network medical bill, according to the American Heart Association. POS members can be responsible for paying up to 40 percent of their non-network medical costs out-of-pocket according to AgencyInfo.net.