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POS vs. PPO , which win?



A point of service plan, is a type of managed care health insurance plan in the United States. It combines characteristics of the health maintenance organization (HMO) and the preferred provider organization (PPO). The POS is based on a managed care foundation—lower medical costs in exchange for more limited choice.



Preferred Provider Organization (PPO) A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan's network.

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comparman POS

POS Pros:

  • Your employees will have the freedom to choose their own PCP, and they can go out of network if necessary.
  • The lower copays and premiums are also very appealing for employees.
  • Employees also do not have any annual deductible requirements that your employees will need to be concerned about.

POS Cons:

  • If employees never go out-of-network, then they may end up wasting part of their premiums.
  • Deductibles can be costly for employees, and choosing a plan that has annual deductible for out-of-network plan can be confusing and wasteful.
  • There is a lot of paperwork involved in a POS plan, particularly if you have to be reimbursed for out-of-network services.

comparman PPO

PPO Pros:

  • There is no need to choose a primary care physician with a PPO program, so that gives employees a little bit more flexibility when choosing healthcare.
  • Employees also have the option of going out of network for care as well, which is not an option in some other types of plans.
  • One of the biggest benefits is that there is very little paperwork for both the employee and the employer.

PPO Cons:

  • For employees, a PPO is one of the higher cost options. That does not necessarily mean the employer will pay more, but it could have that implication.
  • Employees may need pre-authorization for certain types of care, and this might be something that the employee would have to handle themselves.
  • If the employee needs to move out-of-network, then costs can add up quickly.


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