What is a POS plan?
Last updated September 3, 2026.
HealthCare.gov's definition: a POS plan charges less for in-network providers and requires a referral from your primary care doctor to see a specialist. It is the hybrid: HMO-style primary care gatekeeping plus PPO-style out-of-network coverage at a higher price. The daily realities: nominate a primary doctor and go through them, never book a specialist without the referral, emergencies are covered anywhere, and in-network care is where the value sits. It suits people who want one doctor coordinating care and lower premiums than a PPO, with out-of-network as a backup rather than a habit.
What to do
- Pick your primary care doctor; they gate specialist referrals.
- Never see a specialist without the referral.
- Check your doctors are in-network before enrolling.
- Treat out-of-network as backup; it costs meaningfully more.
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