What Is POS
POS stands for Point of Service. It's a type of health insurance plan that combines elements of HMO and PPO coverage. With a POS plan, you choose an in-network primary care doctor who coordinates your care and provides referrals to specialists. You pay lower out-of-pocket costs when you stay in-network, but you have the option to see out-of-network providers at a higher cost, similar to a PPO.
Many state Medicaid programs offer POS plans as part of their managed care options. For example, several states use POS plans as the default coverage for Medicaid beneficiaries who don't select a plan during open enrollment. Some TANF (Temporary Assistance for Needy Families) recipients also gain Medicaid eligibility and may be enrolled in POS plans depending on their state's Medicaid structure.
How POS Differs From Other Plans
The key difference between POS and HMO is flexibility. An HMO typically requires you to use in-network providers exclusively, except in emergencies. A POS plan lets you go out-of-network, though you'll pay more. Unlike a PPO, a POS plan requires you to have a primary care doctor who manages referrals, rather than letting you see specialists directly.
- In-network care: Lower copays and coinsurance; referrals required for specialists
- Out-of-network care: Higher out-of-pocket costs (typically 30-50% coinsurance), but coverage is available without a referral
- Primary care doctor: Required; acts as your care coordinator
- Emergency care: Covered whether in-network or out-of-network
POS in Government Benefits Programs
If you receive Medicaid, your state may automatically assign you to a POS plan or offer it as an option. Under the Medicaid managed care system, approximately 70% of Medicaid beneficiaries nationally are enrolled in some form of managed care, which includes POS plans. Your cost-sharing for Medicaid POS coverage varies by state and income level. Many states have $0 or very low copays for Medicaid members, though some impose modest copayments for non-emergency emergency room visits.
SNAP benefits don't interact with health insurance directly, but your health coverage affects your ability to work and maintain employment, which connects to your SNAP eligibility. WIC (Women, Infants, and Children) participants who also qualify for Medicaid may be assigned to a POS plan. TANF recipients often automatically qualify for Medicaid, so understanding your health plan type matters for accessing preventive care and managing chronic conditions while working toward self-sufficiency.
Common Questions
- Do I need a referral to see a specialist on a POS plan? Yes, if you want to pay in-network rates. You can see a specialist without a referral out-of-network, but you'll pay significantly more. Check with your plan before scheduling to confirm whether a referral is required for in-network coverage.
- Can I change my primary care doctor on a Medicaid POS plan? Most state Medicaid programs allow you to switch primary care doctors during open enrollment (typically once per year) or immediately if you have a qualifying life event like moving or losing your current doctor. Contact your state's Medicaid office to request a change.
- Does a POS plan cover preventive care without copays? Yes. Federal law requires all health plans, including Medicaid POS plans, to cover preventive services like annual physicals, cancer screenings, and vaccinations without cost-sharing when you use in-network providers.