POS plan.

A POS plan is a health plan that uses a primary doctor and referrals like an HMO but still pays something toward out-of-network care like a PPO.

Reviewed by Joseph Citizen, Founder · Last reviewed June 11, 2026

Verified June 2026 · Source: HealthCare.gov

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POS plan

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In plain English

A POS (Point of Service) plan blends features of an HMO and a PPO. Like an HMO, you usually pick a primary care doctor and get referrals to see specialists. Like a PPO, it still pays part of the bill when you go out-of-network, just at a higher cost to you. The name refers to the choice you make at the point you receive care: stay in-network for the best rate, or go outside and pay more. It is a middle-ground plan for people who want some structure but not a hard network wall.

Most useful ages

18 to 64

01Why it matters

A POS plan gives you a backup when you need a doctor outside the network, but skipping the referral step can cut your coverage, so the rules matter to your wallet.

02The math, step by step

You have a POS plan and ask your primary doctor for a referral to an in-network specialist, which keeps your cost low. Later you see an out-of-network specialist without a referral. The plan still pays a portion, but you owe a much larger share than you would have in-network.

03What this is NOT

Do not confuse with An EPO

A POS plan is not an EPO. A POS plan pays part of out-of-network care; an EPO generally pays nothing out-of-network. A POS plan also usually requires referrals, while an EPO usually does not.