Point-of-Service Plan (POS)

A Point-of-Service (POS) plan combines features of an HMO and a PPO. Like an HMO, you choose a primary care physician who coordinates your care and provides referrals. Like a PPO, you have the option to see out-of-network providers — though at a significantly higher cost share.

How a POS plan works in practice:

You designate a PCP who manages your care and issues referrals for specialist visits
In-network care (with referral) is covered at the lower in-network cost-sharing rate
Out-of-network care is covered, but at a higher rate — and typically requires a referral from your PCP
Emergency care is covered regardless of network status, as with all ACA plans

POS plans are less common on the ACA Marketplace than HMOs, PPOs, and EPOs. When available, they offer a middle ground: more provider flexibility than an HMO with more structure than a PPO. The premium typically falls between the two.

Frequently Asked Questions

What’s the difference between a POS and an EPO?

A POS requires a PCP and referrals, like an HMO. An EPO also restricts you to the network but does not require a PCP or referrals. If network access matters and you want direct specialist access without referrals, an EPO is more flexible. If you want the option to occasionally go out-of-network with a referral, a POS provides that while still offering in-network cost control.

Can I see out-of-network providers on a POS plan?

On a POS plan, you can see out-of-network providers, but you’ll typically need a referral from your PCP first, and you’ll pay significantly more — higher coinsurance, a separate out-of-network deductible, and possibly a higher out-of-pocket maximum. Without a referral for out-of-network care, coverage may be denied entirely depending on the plan.

Could we improve this page?

Leave Feedback