PPO vs. POS Plans

When choosing a health plan, you have several options. Two common types are Preferred Provider Organization (PPO) and Point of Service (POS) plans. Understanding the key differences between POS vs. PPO plans can help you choose the plan that’s right for your needs and budget. Read on to learn how these health plans compare and how supplemental insurance plans can provide additional financial support.

3 min. read

Table of Contents

Key Takeaways

PPO plans allow you to choose in- or out-of-network doctors, though seeing an out-of-network doctor may be more expensive.¹
POS plans typically require you to see an in-network primary care provider (PCP) and get a referral before you can see a specialist.²
Aflac offers supplemental insurance plans that can complement both PPO and POS plans by helping you afford expenses your primary health plan may not fully cover.

What is a PPO plan?

A PPO plan is a type of health insurance that lets you choose from a broad network of providers while still giving you the option to visit out-of-network doctors, hospitals and specialists.³

When you see in-network providers, you’ll typically pay less because your insurance company has negotiated lower rates with them. You can also usually see specialists without a referral, which can make it easier to access care when you need it.⁴

PPO plans may offer more flexibility, but they also typically have higher premiums than other plan types.

What is a POS plan?

A POS plan combines features of PPO and Health Maintenance Organization (HMO) plans.⁵

Like PPOs, POS plans may allow you to receive out-of-network care, but it often costs more and may require you to complete additional paperwork.
Like HMOs, POS plans typically require you to choose an in-network PCP to help coordinate your care and obtain referrals for specialist visits. They also dont typically require you to meet a deductible before accessing benefits.⁶

POS plans may be a good fit if you want lower premiums than a PPO offers and don't mind using a PCP to manage your care.

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POS vs. PPO: Key differences explained

The difference between PPO and POS plans comes down to cost, flexibility and referrals. Here’s how these factors compare across plan types:^7,8

Cost: PPO plans typically have higher premiums than POS plans because they offer more provider flexibility. POS plans may cost less, especially if you stay in network.
PCP requirement: Unlike PPO plans, POS plans usually require you to choose an in-network PCP, which can add extra steps when you need care beyond routine visits.
Referrals: POS plans usually require referrals to see specialists, while PPO plans generally allow you to see specialists without referrals.
Out-of-network care: PPO plans can make it easier to see out-of-network providers. POS plans may still allow out-of-network care, but it often costs more and may involve additional steps, such as seeking referrals, paying upfront or submitting claims for reimbursement.

Should I get a PPO or a POS plan?

The right type of health insurance ultimately depends on your preferences, needs and budget.

A PPO plan may be right for you if you want more freedom to choose providers, see specialists without referrals and use out-of-network care when needed. Just keep in mind that you’ll likely pay more for that flexibility.
A POS plan may be right for you if you want lower costs and are comfortable coordinating your care with a PCP and obtaining a referral for specialist visits.

Along with selecting the right plan type, it's important to compare each policy's premiums, provider networks, referral rules and out-of-pocket costs.

Other types of health insurance plans

PPO and POS plans are two common health insurance options. Depending on your needs and budget, you may want to compare PPO and POS with other plan types, including:⁹

HMO plans: These plans typically require you to use in-network providers and get referrals from a PCP to see specialists. Out-of-network care usually isn't covered except in emergencies.
Exclusive Provider Organization (EPO) plans: These managed care plans only cover services if you see doctors and specialists within the network. However, unlike HMOs, they don't require referrals to see a specialist.

POS vs. PPO Frequently Asked Questions

Is a PPO or POS plan better?

The best health plan depends on your health care needs and budget. PPO plans offer more flexibility to see specialists and out-of-network providers without referrals, while POS plans may have lower premiums and more coordinated care through a PCP.

Do POS plans cover out-of-network care?

Many POS plans offer some out-of-network coverage, but it often comes with higher out-of-pocket costs and may require you to take additional steps, such as securing referrals or submitting claims for reimbursement. Coverage details vary by plan.

Do PPO plans require referrals?

PPO plans generally don't require referrals to see specialists. This flexibility can make it easier to schedule appointments and access specialized care when needed.

Can supplemental insurance work with a PPO or POS health plan?

Yes. Supplemental health insurance can work alongside both PPO and POS plans to help cover eligible expenses, such as deductibles, copays, coinsurance and other out-of-pocket costs your primary health insurance may not fully cover.

Complement your PPO or POS plan with supplemental insurance

Whether you have a PPO or POS plan, you may still have some out-of-pocket costs for your health care. That's where supplemental insurance can offer added support.

Aflac's supplemental insurance can help you pay for eligible expenses your primary medical insurance doesn't fully cover. We offer several types of coverage, including cancer insurance, critical illness insurance, hospital insurance, PPO dental insurance, supplemental dental insurance and more.

Speak with an agent today to learn more about Aflac supplemental coverage and get a quote.

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