PPO vs. POS Plans: What’s the Difference? (2024)

In general, the biggest difference between PPO vs. POS plans is flexibility. A PPO, or Preferred Provider Organization, offers a lot of flexibility to see the doctors you want, at a higher cost. POS, or Point of Service plans , have lower costs, but with fewer choices. There are many more details you'll want to compare, as well.

PPO vs. POS: What are the main differences?

When you're comparing health plans it's important to understand what sets them apart from one another. This way you can make a decision based on your needs. Here are some main features that you can compare to find out what makes a PPO different from a POS:

• Costs (deductibles, coinsurance, copays, and premiums)
• Primary Care Provider (PCP) requirement
• In-network requirement
• Referrals to other providers

Comparing costs between PPO and POS

When it comes to the costs for PPO vs. POS plans, how do they stack up?

• Deductibles: PPO plans usually come with a deductible. This means you pay for care and services until the deductible is met. Then your plan starts sharing costs. POS plans typically do not have a deductible as long as you choose a Primary Care Provider (PCP) within your plan's network and get referrals to other providers, if needed.
• Copays: Both PPO and POS plans may require copays. This is a fee you pay to a doctor at the time of a visit or for a prescription medication.
• Coinsurance: You may be required to share some of the costs for your care with both a PPO and POS plan. For a PPO plan, your coinsurance kicks in once you've met your deductible. With a POS plan, coinsurance costs could kick in if you need out-of-network care or fail to get referrals to see other providers.
• Premiums: This is what you pay monthly for your plan. Typically you will have a higher premium with a PPO because it offers more options. The POS plans usually have lower premiums because they offer fewer options.