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POS Point of Service Plans


Currently there are three POS plans for the individual market in Florida. At East Coast Health Insurance, we currently market AvMed, Cigna, and Aetna, which are all the same plan format in that they are POS plans and they should by definition be more or less the same.

Point of Service Defined

A POS plan, known as Point of Service plan, is also based on the basic managed care foundation: lower medical costs in exchange for more limited choice. Still, the POS is different than the HMO or traditional managed care plans in that even though technically upon enrollment you are required to choose a primary care physician to monitor your health care no POS plan in Florida that I know of actually does this. But essentially you end up choosing one anyways and here is where the similarities to the HMO usually end in that you can go to specialists without a referral and even go outside of the network when your point of service physician (your primary doctor) gives you the referrals, but then only some compensation will be offered by your health insurance company.  That compensation is usually after a significant deductible and then coinsurance plateau if you opt for the traditional plan, which of course most people do.  So, in essence a POS is a marriage of HMO managed care and PPO choices.

POS Plan Choices in Florida Health Insurance

In reality, in Florida, unless you go with Aetna, which is the best (and most expensive depending on your zip code and demographic) you are losing much of the flexibility of the Florida PPO and not getting the HMO preventative benefits that make an HMO attractive.

Aetna, however, still pays for all of your testing and diagnostics as long as they occur in your doctors office.  This can save you a ton of money and makes them more attractive in my view than the PPO plans by Humana One in Florida Health Insurance, and Golden Rule or United Health One. AvMed also falls into that same category. In fact, AvMed has zero HMO benefits such as copays for testing, ER copays, anything and everything besides office visits and prescriptions will be applied toward your deductible and subsequent coinsurance.  Cigna is an Open Access plan, but is not considered a POS, though it has very much in common with a POS.  In reality it is a PPO, however.

Florida AvMed, Cigna, and Aetna

The selling point of AvMed and Cigna would then, of course, have to be price and indeed it is as these plans especially in South Florida are among the most inexpensive plans in the area.  Aetna, again, is the most expensive.  On the other hand though, Aetna will pay quite a bit more of your medical bills in a given year.  Still though, no POS health insurance plan in Florida will ever leave you with a bill under $1000 in a Florida emergency room due to their strict deductibles.

This is the reason why East Coast Health Insurance is so set upon either selling the Coventry HMO, the Coventry PPO, and of course the Blue Cross 90 plans (now called 590’s) as they have co-pays for most routine things and can save you a ton of a money in a pinch.  As I said though, they are not always the most affordable but of course until we run the quote  you can not know for sure, unless you are as knowledgeable about products and demographics as me, which most health insurance agents in Florida can’t even claim.


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