Understanding the Networks (PPO vs. POS)
Understand the difference between the networks in our plans, like a PPO or a POS. Understanding the differences can help you choose a plan.
Hi, I’m Ingrid from Blue Cross & Blue Shield of Rhode Island.
Looking for a new plan, but not sure what network to choose?
Finding a network of doctors and hospitals that fits your needs is a smart first step in choosing a health plan.
Let’s talk about some of the differences in our POS and PPO plans.
Our traditional network consists of the state’s largest Medicare Advantage network, including more than 95% of providers in RI.
For our POS plans, the network includes all primary care providers in the BlueCHiP for Medicare network, all hospitals in RI, and 4 in Southeastern MA.
For our PPO plan, it also includes providers within the national Blue Cross PPO network.
For POS plans, you pay a 20% coinsurance to go outside of the traditional network in non-emergency and non-urgent situations.
For our PPO plan, you pay flat dollar copays on most out-of-network benefits.
For our POS plan, referrals are required. Primary care providers coordinate care and help you navigate through the healthcare system.
For our PPO plan, since it’s a national network, referrals are not required.
It also has an open pharmacy network.
So how do you choose? Consider where you typically need care. Is it near home or do you need nationwide access?
If you frequently receive care outside of Rhode Island, HealthMate for Medicare (PPO) may be more cost-efficient.
If you typically receive care near home, the BlueCHiP for Medicare Value plan may be your best option.
We understand you still may have questions.
We’re happy to help!