Is UHC Choice Plus a PPO or POS? Breaking Down the Difference

When it comes to health insurance, understanding the different plan types can be confusing. UHC Choice Plus is a common insurance plan offered by many employers. But is it a PPO or POS plan? What exactly is the difference between PPO and POS anyway? This comprehensive guide examines UHC Choice Plus and explains how to distinguish between PPO and POS plans.

What is UHC Choice Plus?

UHC Choice Plus is the name of a health insurance plan offered by UnitedHealthcare, one of the largest health insurance providers in the U.S. Key features of UHC Choice Plus include:

• Nationwide network – UHC Choice Plus utilizes UnitedHealthcare’s large network of doctors, hospitals, and facilities across the country.

• No referrals – You can see any in-network specialist without needing a referral from a primary care physician.

• Out-of-network coverage – The plan covers out-of-network care, but at a higher cost to the member.

• Copays and deductibles – In addition to premiums, members pay copays for office visits and have an annual deductible to meet.

• Prescription drug coverage – Prescriptions are covered through a partner pharmacy benefit manager, usually CVS Caremark.

Based on these characteristics, UHC Choice Plus is considered a PPO plan or Preferred Provider Organization plan. Next, let’s look at what defines a PPO versus a POS (Point of Service) plan.

PPO Health Insurance Plans

PPO stands for Preferred Provider Organization. Here are the main attributes of a PPO health plan:

• Nationwide network – PPOs provide access to a large network of medical providers across the country.

• No referrals required – You can visit any doctor or specialist in the network without needing a referral.

• Out-of-network coverage – PPOs cover out-of-network care but you pay more compared to staying in-network.

• Annual deductible – There is usually a deductible you must meet before coverage kicks in.

• Copays and coinsurance – You are responsible for copays and a percentage of costs called coinsurance.

• Higher premiums – Monthly premiums tend to be higher for the flexibility of a PPO.

PPOs offer more freedom and flexibility compared to HMO plans which require staying in-network. The tradeoff is higher monthly costs.

POS Health Insurance Plans

POS stands for Point of Service plan. Here are the main features of POS plans:

• PCP referrals – A primary care physician coordinates care and referrals are required to see specialists.

• In- and out-of-network – POS plans have network providers but also offer some out-of-network coverage.

• Higher out-of-network costs – You pay more for out-of-network care through deductibles, copays, and coinsurance.

• Preauthorizations – Some services require preapproval before receiving care.

• Deductibles – There is an annual deductible you must meet before coverage starts.

• Copays and coinsurance – You are responsible for paying copays and coinsurance.

• Lower premiums – Premiums may cost less than a PPO but more than an HMO.

POS plans combine aspects of HMO and PPO plans. They are more restrictive than PPOs but allow some out-of-network access.

How UHC Choice Plus Fits In

Now that we’ve defined PPO and POS plans, it is clear that UHC Choice Plus is a PPO plan. Here is a recap of why:

• UHC Choice Plus has a large nationwide network like a typical PPO.

• There is out-of-network coverage without the need for referrals.

• Premiums tend to be moderate compared to HMO plans.

• Deductibles and copays apply as is common with PPOs.

Conversely, UHC Choice Plus does not have some typical POS features like:

• Requiring a primary care physician

• Needing referrals to see specialists

• Less out-of-network coverage compared to a PPO

While it has “Choice” in the name, the lack of restrictions around referrals and network providers clearly makes UHC Choice Plus a PPO insurance plan.

Pros and Cons of UHC Choice Plus

UHC Choice Plus has several advantages:

Pros

• Large nationwide network
• No need for PCP referrals
• Coverage for out-of-network care
• Lower cost than some PPO plans
• Deductibles relatively low for a PPO

Cons

• Out-of-network costs still high
• Premiums higher than HMO options
• Pre-approvals required for some services
• May need to change doctors if leaving network

The flexibility and reduced costs compared to other PPOs make UHC Choice Plus an attractive choice for many. But the higher premiums compared to HMO plans may make it less affordable for some families.

Is a PPO or POS Plan Right for You?

When deciding between PPO and POS plans, there are a few key factors to consider:

• Current doctors – Do your providers participate in the plan’s network?

• Flexibility – Do you want to easily see out-of-network providers if needed?

• Costs – How much are the monthly premiums and cost-sharing?

• Coordination of care – Do you want a PCP to coordinate referrals?

• Covered services – Does the plan cover the providers, hospitals, medications, and services you need?

Evaluating your healthcare priorities and budget will help determine if a PPO like UHC Choice Plus or POS plan better fits your needs. Consulting with a benefits advisor can provide guidance as well.

The Bottom Line

UHC Choice Plus is a PPO health insurance plan that offers a nationwide network and the ability to see providers in and out-of-network without referrals. But higher premiums make PPOs like UHC Choice Plus more costly than HMO or POS plan options that place some restrictions around networks and referrals in exchange for lower monthly costs.

Understanding the trade-offs between different plan types is critical when selecting health insurance coverage. Looking closely at factors like flexibility, costs, and provider access will ensure you pick the right plan for your healthcare needs and budget.