What distinguishes a Point of Service (POS) plan from an HMO?

A Point of Service (POS) plan is characterized by its hybrid structure, merging elements from both Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). One of the key features of a POS plan is that it requires members to choose a primary care physician (like an HMO), but it also allows flexibility to see out-of-network providers (akin to a PPO) at an additional cost.

This balance enables members to have some level of out-of-network access while still enjoying the lower costs associated with choosing in-network providers. This aspect is what fundamentally distinguishes a POS plan from a purely HMO or PPO plan. An HMO typically restricts members to in-network providers without offering the out-of-network option, whereas a PPO provides the freedom to see out-of-network providers but usually at a higher cost. Therefore, the ability for members to access out-of-network providers, albeit with higher out-of-pocket expenses, is a significant distinguishing feature of the POS plan.